Nursing Elites

1. How should a healthcare professional care for a patient with a central line to prevent infection?

• A. Change the dressing daily
• B. Monitor for redness
• C. Check the central line site every shift
• D. Flush the line with saline

Correct answer: A

Rationale: Corrected Rationale: Changing the central line dressing daily is crucial in preventing infection at the insertion site. This practice helps maintain a clean and sterile environment around the central line, reducing the risk of pathogens entering the bloodstream. Monitoring for redness (choice B) is important but may not directly prevent infection. Checking the central line site every shift (choice C) is essential for early detection of any issues but does not solely prevent infection. Flushing the line with saline (choice D) is a necessary procedure for maintaining central line patency but does not primarily prevent infection.

2. A nurse is caring for a client who is scheduled for a colonoscopy. Which of the following findings should the nurse report to the provider?

• A. Client reports taking ibuprofen daily
• B. Client has a history of asthma
• C. Client reports drinking one glass of wine daily
• D. Client has a history of diverticulitis

Correct answer: A

Rationale: The correct answer is A. Ibuprofen is an NSAID that can increase the risk of bleeding during a colonoscopy due to its effects on platelet function. It is important to report this finding to the provider to consider alternative pain management options. Choices B, C, and D are not the most pertinent to report for a colonoscopy. Asthma and a history of diverticulitis are relevant medical history but do not directly impact the colonoscopy procedure. Drinking one glass of wine daily is not a concern specifically related to the colonoscopy procedure.

3. A nurse is providing discharge instructions to a client who has a new prescription for warfarin. Which of the following statements indicates a need for further teaching?

• A. I will avoid leafy green vegetables while taking warfarin.
• B. I will have my INR checked regularly while taking warfarin.
• C. I will use a soft toothbrush while taking warfarin.
• D. I will take this medication at the same time each day.

Correct answer: A

Rationale: The correct answer is A. Clients taking warfarin should avoid leafy green vegetables because they are high in vitamin K, which can interfere with the effectiveness of warfarin by counteracting its anticoagulant effects. Choices B, C, and D are all correct statements related to taking warfarin. Regular INR monitoring is necessary to ensure the medication is within the therapeutic range, using a soft toothbrush reduces the risk of bleeding gums, and taking the medication at the same time daily helps maintain consistent blood levels.

4. What is the best method to assess pain in a non-verbal patient?

• A. Observe for facial expressions
• B. Observe for restlessness
• C. Observe for sweating
• D. Check for non-verbal cues

Correct answer: A

Rationale: The correct answer is to observe for facial expressions when assessing pain in a non-verbal patient. Facial expressions can provide vital clues about the patient's pain level and discomfort. Choices B and C, observing for restlessness and sweating, can be less specific and may indicate other issues besides pain. Choice D, checking for non-verbal cues, is too broad and does not specify the crucial aspect of focusing on facial expressions.

5. A nurse is caring for a client who has severe preeclampsia and is receiving magnesium sulfate intravenously. The nurse discontinues the magnesium sulfate after the client displays toxicity. Which of the following actions should the nurse take?

• A. Position the client supine.
• B. Prepare an IV bolus of dextrose 5% in water.
• C. Administer methylergonovine IM.
• D. Administer calcium gluconate IV.

Correct answer: D

Rationale: Administering calcium gluconate IV is the correct action when a client displays toxicity from magnesium sulfate. Calcium gluconate is used as the antidote for magnesium sulfate toxicity as it counteracts the effects. Positioning the client supine (Choice A) is not the immediate action needed. Administering dextrose 5% in water (Choice B) is not indicated for magnesium sulfate toxicity. Administering methylergonovine IM (Choice C) is used in postpartum hemorrhage, not for magnesium sulfate toxicity.

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