Nursing Elites

1. A client scheduled for arthroplasty expresses concern about the risk of acquiring an infection from a blood transfusion. Which of the following statements should the nurse make to the client?

• A. Donate autologous blood before the surgery
• B. Request a specific blood type from the donor
• C. Use blood from a family member
• D. Accept allogeneic blood without concerns

Correct answer: A

Rationale: The correct statement for the nurse to make to the client is to 'Donate autologous blood before the surgery.' Autologous blood donation involves collecting and storing the client's own blood for potential use during surgery, which significantly reduces the risk of transfusion-related infections. This option directly addresses the client's concern about infection risk. Requesting a specific blood type from a donor (Choice B) is not as effective in reducing infection risk compared to autologous blood donation. Using blood from a family member (Choice C) carries the risk of transfusion reactions and infections due to compatibility issues. Accepting allogeneic blood without concerns (Choice D) does not address the client's specific concern about infection risk and is not the most appropriate option in this situation.

2. A nurse is counseling an older adult who describes having difficulty with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority?

• A. “I spent my whole life dreaming about retirement, and now I wish I had my job back.”
• B. “It’s been so stressful for me to have to depend on my child to help around the house.”
• C. “I just heard my friend Al die. That’s the third one in 3 months.”
• D. “I keep forgetting which medications I have taken during the day.”

Correct answer: C

Rationale: The correct answer is C. The statement expressing the loss of friends is the priority issue as it indicates potential grief and emotional distress. Losing multiple friends within a short period can have a profound impact on an older adult's emotional well-being. Option A expresses regret but does not indicate an immediate emotional crisis. Option B focuses on stress related to dependence, which is important but not as urgent as coping with loss. Option D highlights a memory concern, which is significant but does not address the emotional impact of loss.

3. A nurse is caring for a client who has a new prescription for tube feeding. The nurse understands that the provider prescribed tube feeding because the client:

• A. Is unable to swallow foods by mouth
• B. Has a gastrointestinal obstruction
• C. Requires additional caloric intake to support healing
• D. Is at risk for aspiration

Correct answer: A

Rationale: The correct answer is A: 'Is unable to swallow foods by mouth.' Tube feeding is prescribed when a client is unable to safely swallow food by mouth but has a functional gastrointestinal tract. Option B, 'Has a gastrointestinal obstruction,' is incorrect as tube feeding is not typically prescribed for this reason. Option C, 'Requires additional caloric intake to support healing,' is incorrect because tube feeding is specifically for clients who are unable to swallow. Option D, 'Is at risk for aspiration,' is also incorrect as tube feeding would not be the primary intervention for aspiration risk; other strategies to reduce aspiration risk would be implemented instead.

4. A healthcare professional is preparing to administer enoxaparin subcutaneously to a client. Which of the following actions should the healthcare professional take?

• A. Administer the medication with the needle at a 45-degree angle.
• B. Administer the medication with the needle at a 90-degree angle.
• C. Inject the medication into the muscle.
• D. Pinch the skin before injecting.

Correct answer: B

Rationale: Enoxaparin is a medication that is administered subcutaneously, which means it should be injected into the fatty tissue layer beneath the skin. Administering enoxaparin at a 90-degree angle ensures proper absorption and reduces the risk of injecting the medication into muscle tissue, which could affect its effectiveness. Injecting the medication at a 45-degree angle may lead to improper absorption as it may not reach the subcutaneous tissue adequately. Injecting the medication into the muscle instead of subcutaneously can alter the absorption rate and therapeutic effects. Pinching the skin before injecting is not necessary for administering enoxaparin subcutaneously and may cause unnecessary discomfort to the client.

5. A client has been admitted to the Coronary Care Unit with a myocardial infarction. Which nursing diagnosis should have priority?

• A. Pain related to ischemia
• B. Risk for altered elimination: constipation
• C. Risk for complication: dysrhythmias
• D. Anxiety related to pain

Correct answer: A

Rationale: The correct answer is A: Pain related to ischemia. This nursing diagnosis should have priority because addressing the pain caused by ischemia is crucial in managing the client's myocardial infarction. Pain management is essential not only for the client's comfort but also for improving outcomes and reducing complications. Choices B, C, and D are not the priority in this scenario. Risk for altered elimination: constipation (Choice B) is not as immediate a concern as managing the client's pain. Risk for complication: dysrhythmias (Choice C) may be a potential concern but addressing the client's pain takes precedence. Anxiety related to pain (Choice D) is important to address but should come after managing the pain itself.

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