Nursing Elites

1. A nurse is teaching about foot care to a client who has diabetes mellitus (DM). What statement indicates understanding?

• A. I should wear my slippers whenever I am out of bed
• B. I can walk barefoot at home
• C. I should apply lotion between my toes
• D. I can soak my feet in warm water

Correct answer: A

Rationale: The correct answer is A. Wearing slippers or shoes when out of bed is crucial for clients with diabetes as it protects the feet from injury. Walking barefoot, as mentioned in option B, can increase the risk of cuts, sores, and infections in diabetic patients. Applying lotion between the toes, as stated in option C, can lead to maceration and increase the risk of fungal infections. Similarly, soaking feet in warm water, as mentioned in option D, can cause skin breakdown and should be avoided by diabetic patients.

2. A charge nurse discovers that a nurse did not notify the provider that a client's condition had changed. The charge nurse should identify that the nurse is accountable for which of the following torts?

• A. Assault
• B. Battery
• C. Negligence
• D. False imprisonment

Correct answer: C

Rationale: The correct answer is C: Negligence. Negligence refers to the failure to take reasonable care or fulfill a duty, which can cause harm to others. In this scenario, the nurse's failure to notify the provider of a change in the client's condition constitutes negligence as it breaches the standard of care expected in healthcare practice. Choice A, Assault, involves the threat of harmful or offensive contact, which is not applicable in this situation. Choice B, Battery, refers to the intentional harmful or offensive touching of another person without their consent, which is also not relevant here. Choice D, False imprisonment, involves the intentional confinement or restraint of an individual against their will, which is not the issue described in the scenario. Therefore, the most appropriate tort in this case is negligence.

3. A nurse is preparing to feed a newly admitted client with dysphagia. Which of the following actions should the nurse take?

• A. Instruct the client to lift their chin when swallowing
• B. Discourage the client from coughing during feedings
• C. Sit at or below the client’s eye level during feedings
• D. Talk with the client during feedings

Correct answer: C

Rationale: The correct answer is C. Sitting at or below the client’s eye level is important when feeding a client with dysphagia. This position allows the nurse to closely observe the client for any signs of difficulty with swallowing, which can help prevent aspiration. Instructing the client to lift their chin when swallowing (choice A) is not recommended for clients with dysphagia as it can increase the risk of aspiration. Discouraging the client from coughing during feedings (choice B) is also not correct, as coughing may be a protective mechanism to prevent aspiration. Talking with the client during feedings (choice D) may distract the client and interfere with their ability to focus on swallowing safely.

4. A nurse is caring for a group of clients in a long-term care facility. Which of the following situations should the nurse recognize as a safety hazard?

• A. A client’s wrist restraints tied to the bed rails
• B. A client’s bedside table placed across the foot of the bed
• C. A meal tray left at the bedside from breakfast
• D. A call light extension cord pinned to the bedspread

Correct answer: A

Rationale: The correct answer is A. Tying wrist restraints to the bed rails is a safety hazard because if the bed rails are lowered, the restraints can tighten and cause injury or asphyxiation. Choice B, placing a bedside table across the foot of the bed, may not be ideal for convenience but does not pose a direct safety hazard. Choice C, leaving a meal tray at the bedside from breakfast, is more of an infection control issue than an immediate safety hazard. Choice D, having a call light extension cord pinned to the bedspread, is also not a direct safety hazard unless it poses a risk of entanglement or tripping, which is not indicated in the scenario.

5. A nurse is planning to administer an injection of morphine to a client. Which of the following actions should the nurse take to ensure client safety?

• A. Instruct the client to take a deep breath during administration.
• B. Administer the medication over 30 seconds.
• C. Verify the client’s pain level.
• D. Have naloxone available in case of respiratory depression.

Correct answer: D

Rationale: The correct answer is to have naloxone available in case of respiratory depression. Morphine is an opioid that can lead to respiratory depression, especially in higher doses. Naloxone is the antidote for opioid overdose and should be readily accessible when administering morphine to reverse respiratory depression if it occurs. Instructing the client to take a deep breath during administration (choice A) is not directly related to ensuring safety in this scenario. Administering the medication over 30 seconds (choice B) may help with the comfort of the client but does not address the potential risk of respiratory depression. Verifying the client's pain level (choice C) is important but not the primary action to ensure safety when administering morphine.

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