Nursing Elites

1. When planning to discharge a client receiving home oxygen therapy, which of the following instructions should the nurse include in the discharge teaching?

• A. Ensure that electrical cords are not frayed
• B. Keep oxygen tanks in a horizontal position
• C. Store extra oxygen tanks in a closed closet
• D. Apply petroleum-based gel to the inside of the nostrils

Correct answer: A

Rationale: The correct answer is to ensure that electrical cords are not frayed. Frayed electrical cords pose a fire hazard when oxygen is in use. Keeping oxygen tanks in a horizontal position (Choice B) is important to prevent leaks but is not the priority compared to fire safety. Storing extra oxygen tanks in a closed closet (Choice C) is also important but not as immediate as preventing fire hazards. Applying petroleum-based gel to the inside of the nostrils (Choice D) is unrelated to oxygen therapy safety and is not recommended.

2. A nurse is caring for a patient who has been in a motor vehicle crash and has a minor traumatic brain injury (TBI). What finding should the nurse recognize as a complication and report to the provider?

• A. Hypertension
• B. Vomiting
• C. Drainage from the ear
• D. Unequal pupils

Correct answer: D

Rationale: Unequal pupils are a sign of increased intracranial pressure or worsening brain injury, indicating a serious complication that requires immediate medical attention. Hypertension, vomiting, and drainage from the ear are not typically associated with minor traumatic brain injury complications; therefore, they are not the priority findings to report to the provider.

3. A nurse is providing dietary teaching to a client who is at risk for cardiovascular disease. Which of the following foods should the nurse recommend?

• A. Fried chicken
• B. Oatmeal
• C. Bacon
• D. Whole milk

Correct answer: B

Rationale: Oatmeal is high in fiber, which helps lower cholesterol levels, making it a heart-healthy food option for clients at risk for cardiovascular disease. Fried chicken, bacon, and whole milk are high in saturated fats and cholesterol, which can increase the risk of heart disease and should be limited in the diet of individuals at risk for cardiovascular issues.

4. A nurse is planning care for four clients. Which client is the highest priority?

• A. Client with dry, black eschar on the heel
• B. Client wearing an arm cast and reporting numb fingers
• C. Client with reddened skin around the coccyx
• D. Client with frequent incontinence

Correct answer: B

Rationale: The correct answer is B because numb fingers indicate neurovascular compromise, which can lead to serious complications if not addressed promptly. The priority in this situation is to assess and address any circulation issues affecting the extremity. Choices A, C, and D are of concern but not as immediate as neurovascular compromise, which requires urgent attention to prevent further complications.

5. A nurse is caring for an older adult who has a nonpalpable skin lesion that is less than 0.5 cm (0.2 in) in diameter. Which of the following terms should the nurse use to document this finding?

• A. Papule
• B. Vesicle
• C. Macule
• D. Nodule

Correct answer: C

Rationale: The correct term the nurse should use to document this finding is 'Macule.' A macule is a flat, nonpalpable skin lesion that is smaller than 1 cm in diameter. In this case, the lesion described is less than 0.5 cm, making it appropriate to classify it as a macule. 'Papule' (Choice A) refers to a solid, elevated skin lesion, 'Vesicle' (Choice B) is a small fluid-filled blister, and 'Nodule' (Choice D) is a solid, elevated skin lesion that is larger and deeper than a papule, none of which accurately describe the lesion in question.

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