Nursing Elites

1. A nurse is caring for a client who is postpartum and reports perineal pain. Which intervention should the nurse implement?

• A. Administer analgesics as prescribed.
• B. Apply a warm compress to the perineum.
• C. Encourage the client to ambulate frequently.
• D. Position the client with the head elevated.

Correct answer: A

Rationale: Administering analgesics as prescribed is the appropriate intervention for managing perineal pain in a postpartum client. Analgesics help to alleviate discomfort and promote the client's recovery. Applying a warm compress (choice B) may provide some relief, but it does not address the pain as effectively as analgesics. Encouraging ambulation (choice C) and positioning the client with the head elevated (choice D) are not directly related to addressing perineal pain.

2. A nurse is caring for a client who has pneumonia. Which of the following findings should the nurse report to the provider immediately?

• A. Increased appetite
• B. Productive cough with green sputum
• C. Cyanosis of the lips and nail beds
• D. Mild shortness of breath

Correct answer: C

Rationale: The correct answer is C: Cyanosis of the lips and nail beds. Cyanosis is a late sign of hypoxia and indicates severe oxygen deprivation, requiring immediate intervention in clients with pneumonia. Reporting this finding promptly is crucial to prevent further complications. Choices A, B, and D are incorrect because increased appetite, productive cough with green sputum, and mild shortness of breath are common findings in clients with pneumonia and may not require immediate intervention unless they worsen or are accompanied by other concerning symptoms.

3. A client is at risk for developing deep vein thrombosis (DVT). Which of the following actions should the nurse take?

• A. Encourage the client to remain on bed rest.
• B. Massage the client's legs every 4 hours.
• C. Apply sequential compression devices to the client's legs.
• D. Administer anticoagulants as prescribed.

Correct answer: C

Rationale: The correct action the nurse should take for a client at risk for developing DVT is to apply sequential compression devices to the client's legs. This intervention helps prevent venous stasis by promoting circulation and reducing the risk of DVT. Encouraging the client to remain on bed rest (Choice A) can actually increase the risk of DVT due to immobility. Massaging the client's legs every 4 hours (Choice B) can dislodge blood clots and is contraindicated in DVT prevention. While administering anticoagulants as prescribed (Choice D) is a treatment for DVT, it is not a preventive measure for a client at risk.

4. A nurse is caring for a client who has a new temporary synchronous pacemaker. Which of the following should the nurse report to the provider?

• A. The client's pulse oximetry level is 96%.
• B. The client develops hiccups.
• C. The ECG shows pacing spikes after the QRS complex.
• D. The client's heart rate is 90 beats per minute.

Correct answer: C

Rationale: The correct answer is C. Pacing spikes after the QRS complex indicate a malfunction of the pacemaker and should be reported. Choice A is not directly related to the pacemaker function. Choice B, hiccups, are common and not typically associated with pacemaker issues. Choice D, a heart rate of 90 beats per minute, is within the normal range and does not indicate a pacemaker malfunction.

5. A nurse is preparing discharge information for a client who has type 2 diabetes mellitus. Which resource should the nurse provide?

• A. Personal blogs about managing diabetes medications.
• B. Food exchange lists for meal planning from the American Diabetes Association.
• C. Diabetes medication information from the Physicians' Desk Reference.
• D. Food label recommendations from the Institute of Medicine.

Correct answer: B

Rationale: The correct answer is B: Food exchange lists for meal planning from the American Diabetes Association. Food exchange lists provide structured meal planning for individuals with diabetes, helping them make healthier food choices and manage their condition effectively. Choice A is incorrect because personal blogs may not provide accurate and reliable information on managing diabetes and medications. Choice C is incorrect as diabetes medication information may not be directly related to meal planning and dietary management. Choice D is incorrect because food label recommendations from the Institute of Medicine may not specifically cater to the dietary needs and meal planning guidelines recommended for individuals with diabetes.

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