Nursing Elites

1. A nurse is caring for a client who is in labor and has an external fetal monitor in place. The nurse observes late decelerations in the fetal heart rate. Which of the following actions should the nurse take first?

• A. Decrease the client's IV fluids
• B. Reposition the client
• C. Administer oxygen by face mask
• D. Document the findings

Correct answer: C

Rationale: Administering oxygen by face mask is the priority intervention when late decelerations are observed in the fetal heart rate. Late decelerations indicate uteroplacental insufficiency, and administering oxygen helps to improve fetal oxygenation. Repositioning the client may also be necessary to relieve pressure on the umbilical cord, but providing oxygen takes precedence to enhance fetal oxygenation. Decreasing IV fluids may not directly address the underlying issue leading to late decelerations. Documenting the findings is important but should not be the first action taken when managing late decelerations.

2. A client undergoing surgery refuses to remove religious jewelry. What is the best course of action?

• A. Proceed with surgery while securing the jewelry to the patient.
• B. Remove the jewelry and document the removal.
• C. Document the refusal and delay the surgery.
• D. Remove the jewelry with the family's permission.

Correct answer: B

Rationale: The correct course of action is to remove the jewelry and document the removal. While religious beliefs should be respected, ensuring patient safety during surgery is crucial. Securing the jewelry may not be sufficient to prevent any interference during the surgical procedure. Documenting the removal is important for legal and documentation purposes. Delaying the surgery or removing the jewelry with the family's permission may not be the best options as patient safety should be the top priority in this situation.

3. What are the nursing priorities when caring for a patient with a newly placed peripherally inserted central catheter (PICC)?

• A. Performing sterile dressing changes
• B. Educating the patient on PICC line care
• C. Flushing the PICC line as prescribed
• D. Inspecting the insertion site for signs of infection

Correct answer: A

Rationale: The correct answer is A: Performing sterile dressing changes. When caring for a patient with a newly placed PICC line, one of the nursing priorities is to ensure proper care of the insertion site by performing sterile dressing changes. This helps prevent infections and maintain the integrity of the line. While educating the patient on PICC line care, flushing the PICC line as prescribed, and inspecting the insertion site for signs of infection are important aspects of care, the priority immediately after insertion is to maintain the sterility of the site through proper dressing changes.

4. A nurse manager of a rural clinic is orienting a new employee. Which of the following information should the nurse include as a characteristic of rural health?

• A. Lower rates of maternal morbidity
• B. Reduced incidence of death from motor-vehicle crashes
• C. Increased rates of chronic illness
• D. More frequent dental preventative care visits

Correct answer: C

Rationale: The correct answer is C: 'Increased rates of chronic illness.' Rural areas often face challenges such as limited access to healthcare services, healthcare provider shortages, socioeconomic factors, and lifestyle choices that contribute to higher rates of chronic illnesses. Maternal morbidity rates are typically higher in rural areas due to limited access to obstetric care. While rural areas may have fewer motor-vehicle crashes compared to urban areas, the severity of crashes is usually higher due to factors like longer emergency response times. Dental care access can also be limited in rural areas, leading to less frequent preventative care visits.

5. What is a key characteristic of Illness Anxiety Disorder?

• A. Excessive focus on minor symptoms without medical evidence of illness
• B. The need for consistent reassurance from healthcare professionals
• C. Compulsive behavior to avoid physical illness
• D. Development of avoidance behaviors to reduce anxiety

Correct answer: A

Rationale: The correct answer is A: "Excessive focus on minor symptoms without medical evidence of illness." Illness Anxiety Disorder, formerly known as hypochondriasis, is characterized by a preoccupation with having a serious illness despite no medical evidence to support the presence of an illness. Individuals with this disorder often interpret normal bodily sensations as signs of severe illness. Choice B is incorrect because while individuals with Illness Anxiety Disorder may seek reassurance from healthcare professionals, the excessive focus on minor symptoms is the key characteristic. Choice C is incorrect as compulsive behaviors to avoid physical illness are more characteristic of illnesses like Obsessive-Compulsive Disorder. Choice D is incorrect as the development of avoidance behaviors to reduce anxiety is more commonly seen in conditions like specific phobias or social anxiety disorder.

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