Nursing Elites

1. After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, 'I have had it with that client. I just can't do anything that pleases him. I'm not going in there again.' The nurse should respond by saying

• A. He has a lot of problems. You need to have patience with him.
• B. I will talk with him and try to figure out what to do.
• C. He is scared and taking it out on you. Let's talk to figure out what to do.
• D. Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day.

Correct answer: C

Rationale: The correct response is to acknowledge the UAP's feelings while exploring the client's behavior. By stating, 'He is scared and taking it out on you. Let's talk to figure out what to do,' the nurse shows empathy and readiness to address the situation collaboratively. This approach helps maintain a therapeutic environment for both the UAP and the client. Choices A and D are dismissive and do not address the underlying issue or provide support. Choice B, while showing willingness to intervene, lacks the understanding of the client's potential fear and does not address the UAP's feelings.

2. The nurse assesses a client’s wound. What type of wound requires immediate intervention by the nurse?

• A. Laceration
• B. Abrasion
• C. Contusion
• D. Ulceration

Correct answer: A

Rationale: Lacerations, especially deep ones, are prone to bacterial contamination and may require immediate intervention to prevent infection. Abrasions, contusions, and ulcerations are not as likely to lead to immediate serious complications like infections as lacerations.

3. The nurse is caring for a client who has COPD and chest pain related to a recent fall. What nursing intervention requires the greatest caution when caring for a client with COPD?

• A. Administering narcotics for pain relief
• B. Encouraging the client to increase fluid intake
• C. Applying oxygen therapy at a high flow rate
• D. Assisting the client with deep breathing exercises

Correct answer: C

Rationale: The correct answer is C: Applying oxygen therapy at a high flow rate. In clients with COPD, high levels of supplemental oxygen can suppress the hypoxic drive to breathe, leading to carbon dioxide retention and respiratory depression. Oxygen therapy must be administered cautiously to prevent worsening respiratory status. Administering narcotics for pain relief (Choice A) can be necessary but should be done judiciously. Encouraging fluid intake (Choice B) and assisting with deep breathing exercises (Choice D) are generally beneficial interventions for clients with COPD and should not require the same level of caution as high-flow oxygen therapy.

4. A client with Alzheimer's disease is exhibiting signs of agitation and aggression. What is the nurse's priority intervention?

• A. Reassure the client and provide emotional support.
• B. Redirect the client to a quiet activity.
• C. Administer a PRN dose of lorazepam.
• D. Apply soft restraints as needed to prevent harm.

Correct answer: B

Rationale: The correct answer is to redirect the client to a quiet activity. This intervention helps reduce agitation and aggression in clients with Alzheimer's disease by providing a distraction and promoting a calming environment. Reassuring the client and providing emotional support (Choice A) can be beneficial but is not the priority in this situation. Administering a PRN dose of lorazepam (Choice C) should not be the first intervention due to the risk of adverse effects and should only be considered if other non-pharmacological interventions are ineffective. Applying restraints (Choice D) should be avoided unless absolutely necessary for the client's safety as it can lead to further distress and is not the initial priority intervention.

5. An unlicensed assistive personnel (UAP) reports a weak pulse of 44 beats per minute in a client. What action should the charge nurse implement?

• A. Have the UAP recheck the pulse and report back.
• B. Have a licensed practical nurse (LPN) assess the client for apical-radial pulse deficit.
• C. Call the healthcare provider for further instructions.
• D. Immediately call the healthcare provider and prepare for transfer to critical care.

Correct answer: B

Rationale: The correct action is to have a licensed practical nurse (LPN) assess the client for an apical-radial pulse deficit. This assessment can provide further information about the client’s cardiovascular status and help determine if further intervention is necessary. Having the UAP recheck the pulse may delay appropriate assessment and intervention. Calling the healthcare provider for further instructions may not be necessary at this point unless the LPN assessment indicates a need for it. Immediately transferring the client to critical care without further assessment is not warranted based solely on the initial report of a weak pulse.

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