Nursing Elites

1. An 85-year-old client is eligible for Medicare-reimbursable home care services. Referral is contingent on meeting which of the following criteria?

• A. homebound status, requiring skilled therapy care
• B. immediate previous hospitalization for acute care
• C. age
• D. requirement of nursing and social work support

Correct answer: A

Rationale: The correct criteria for Medicare-reimbursable home care services include the client being homebound and requiring a skilled service, such as physical therapy, occupational therapy, speech therapy, nursing, or social work. Choice A is correct because it aligns with these requirements. Choice B is incorrect as immediate previous hospitalization is not a prerequisite for home care services. Choice C is incorrect as age alone does not determine eligibility for Medicare-reimbursable home care services. Choice D is incorrect as the requirement of nursing and social work support alone is not sufficient for Medicare-reimbursable home care services.

2. A nurse is assigned to care for four clients. Which client should the nurse assess first?

• A. A client scheduled for a colonoscopy
• B. A client with a tracheostomy who is receiving humidified oxygen via a tracheostomy mask
• C. A client preparing for discharge after surgery
• D. A client requiring a tube feeding through a gastrostomy tube

Correct answer: B

Rationale: The correct answer is a client with a tracheostomy who is receiving humidified oxygen via a tracheostomy mask. Airway management is always the priority in nursing care. Assessing this client first ensures that their airway is clear and oxygenation is adequate. Clients with compromised airways need immediate attention to prevent respiratory distress or failure. The other clients do not have immediate airway concerns and represent lower priorities in this scenario. Therefore, the nurse should prioritize assessing the client with the tracheostomy and oxygen therapy to maintain airway patency and adequate oxygenation.

3. A nurse witnesses a client sign the consent form for surgery with the surgeon. As the surgeon leaves, the client starts to speak and then stops. The nurse asks if the client has further questions, and he says, "I don't want to bother the surgeon."? The nurse should ____.

• A. acknowledge the client's wish not to bother the surgeon and tell the client to let you know if they change their mind
• B. acknowledge the client's wish not to bother the surgeon and answer all of their questions, as appropriate
• C. go get the surgeon to answer all of the client's questions
• D. answer any questions as appropriate as well as have the surgeon come back to answer any questions if needed

Correct answer: D

Rationale: In this scenario, the nurse should prioritize the client's understanding and comfort. While acknowledging the client's wish not to bother the surgeon is important, it is equally crucial to ensure that the client's questions are answered appropriately and thoroughly. Choice A is correct as it respects the client's initial sentiment and offers the client the opportunity to ask questions later if needed. Choice B is incorrect as it suggests answering all questions immediately, without considering the client's feelings. Choice C is incorrect as it bypasses the nurse's role in addressing the client's concerns. Choice D, the correct answer, balances respecting the client's wish and ensuring that all questions are appropriately addressed, even if it involves the surgeon returning.

4. In what order should the LPN see the following clients? Use appropriate letters to match the correct order

• A. A, D, B, C
• B. C, B, D, A
• C. D, C, B, A
• D. B, C, A, D

Correct answer: B

Rationale: The correct order for the LPN to see the clients is C, B, D, A. It is crucial to prioritize client care based on the urgency of their conditions. The 53-year-old client with lower leg swelling complaining of sudden onset headache and blurry vision (Client C) should be seen first as they are at the highest risk for serious healthcare complications. Next, the LPN should attend to the 23-year-old client with a left arm fracture after an MVA complaining of significant pain in his arm (Client B). Following that, the LPN can address the 47-year-old client requesting more information regarding her surgery scheduled in three hours (Client D). Lastly, the LPN should attend to the 72-year-old client with pneumonia asking to order her dinner (Client A). This order ensures that the most critical needs are met first, followed by the less urgent ones. Choice A is incorrect as it places the 72-year-old client before the 23-year-old client with a painful arm. Choice B is incorrect as it prioritizes the 53-year-old client last. Choice D is incorrect as it does not address the urgency of the clients' conditions appropriately.

5. Which of the following statements indicates that the provider understands how to promote rest and sleep for the client?

• A. If you would prefer not to be disturbed, we can postpone all vital signs and assessments until tomorrow morning.
• B. With your physical therapy appointments, you cannot nap more during the day even if your sleep is often interrupted at nighttime.
• C. I can try to incorporate any sleep rituals or an ideal bedtime into your routine.
• D. We cannot group together medications, assessments, and other interventions so you may have multiple interruptions at night.

Correct answer: C

Rationale: The correct answer is, 'I can try to incorporate any sleep rituals or an ideal bedtime into your routine.' To promote rest and sleep, the provider should consider incorporating the client's preferred sleep rituals or bedtime routine. This statement shows an understanding of the importance of individualizing care to promote restful sleep. Choices A, B, and D do not directly address promoting rest and sleep. Choice A focuses on postponing assessments, Choice B addresses napping during the day, and Choice D mentions multiple interruptions at night, none of which directly support promoting rest and sleep for the client.

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