Nursing Elites

1. A nurse is caring for a group of clients. How should the nurse prevent the spread of infection?

• A. Place a client with TB in a negative pressure room.
• B. Use standard precautions only.
• C. Place a client with TB in a private room.
• D. Use barrier precautions only.

Correct answer: A

Rationale: The correct answer is to place a client with TB in a negative pressure room. Tuberculosis (TB) is an airborne infectious disease, and placing the client in a negative pressure room helps prevent the spread of the infection by containing and filtering the air within the room. Standard precautions (Choice B) are important for preventing the spread of infection in general, but specific precautions are needed for airborne diseases like TB. Placing the client in a private room (Choice C) may not provide adequate ventilation and containment of airborne pathogens. Using barrier precautions (Choice D) alone is not sufficient for preventing the airborne transmission of TB.

2. A nurse on a medical-surgical unit is caring for a client. Which of the following actions should the nurse take first when using the nursing process?

• A. Obtain client information
• B. Develop a plan of care
• C. Implement nursing interventions
• D. Evaluate the client's response to treatment

Correct answer: A

Rationale: The correct answer is A: Obtain client information. The first step in the nursing process is assessment, which involves gathering data about the client's condition, needs, and preferences. This information forms the foundation for developing a comprehensive plan of care. Developing a plan of care (Choice B) comes after assessment to address the identified needs. Implementing nursing interventions (Choice C) follows the development of the plan of care. Evaluating the client's response to treatment (Choice D) occurs after implementing the interventions to determine the effectiveness of the care provided. Therefore, the initial and priority step is to obtain client information through assessment.

3. A school-aged child has had a long leg (hip to ankle) synthetic cast applied 4 hours ago. Which statement from the mother indicates that teaching has been inadequate?

• A. I will keep the cast covered the next day to prevent skin burning.
• B. I can apply an ice pack over the area to relieve itching inside the cast.
• C. The cast should be propped on at least 2 pillows when my child is lying down.
• D. I think I remember that standing cannot be done until after 72 hours.

Correct answer: D

Rationale: The correct answer is D because there is no need to wait 72 hours before allowing the child to stand. The synthetic cast does not affect weight-bearing capacity, and standing can be done as tolerated. Choice A is incorrect because keeping the cast covered can lead to damage or accidents. Choice B is acceptable as applying an ice pack can help relieve itching. Choice C is also correct as elevating the cast on pillows can help reduce swelling and promote comfort during rest.

4. A client with heart failure is being taught by a nurse on reducing daily sodium intake. Which factor is most crucial in determining the client’s ability to learn new dietary habits?

• A. The client's involvement in planning the change
• B. The cost of the dietary changes
• C. The availability of low-sodium foods
• D. The client’s previous dietary knowledge

Correct answer: D

Rationale: The client’s previous dietary knowledge is the most critical factor in determining the ability to learn new dietary habits. Understanding the client's existing dietary knowledge helps tailor the teaching to build upon what they already know. While client involvement in planning changes can increase adherence and motivation, the foundational knowledge is essential for effective learning. The cost of dietary changes and the availability of low-sodium foods are important considerations but not as crucial as the client's existing knowledge.

5. A postoperative client is reporting pain at a level of 2 on a scale of 0 to 10. What is an indication that the client understands pain management?

• A. It might help me to listen to music while lying in bed.
• B. I should try to sleep as much as possible to avoid pain.
• C. I don’t need pain medication if my pain is only at a 2.
• D. I will try to use the pain management techniques suggested by the nurse.

Correct answer: A

Rationale: The correct answer is A because understanding pain management involves considering non-pharmacological approaches, such as listening to music for relaxation and comfort. Choice B is incorrect as excessive sleep may not be an effective pain management strategy. Choice C is incorrect because pain medication may still be necessary even if pain levels are low. Choice D is not the best answer, as it simply states following the nurse’s suggestions without demonstrating an understanding of personalized pain management techniques.

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