Nursing Elites

1. The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:

• A. Perform the procedure safely and correctly.
• B. Critique the nurse's performance of the procedure.
• C. Explain all steps of the procedure correctly.
• D. Correctly answer a posttest about the procedure.

Correct answer: A

Rationale: The correct answer is A. Learning is best demonstrated by a change in behavior. A client who can safely and correctly perform the procedure shows they have acquired the skill. Choice B is incorrect because critiquing the nurse's performance does not directly demonstrate the client's ability to perform the procedure. Choice C is incorrect because explaining the steps does not guarantee the client can physically perform the injection. Choice D is incorrect as answering a posttest only assesses theoretical knowledge, not practical application.

2. A client scheduled for the surgical creation of an ileal conduit expresses anxiety and asks about having a drainage tube. How should the nurse respond?

• A. I will ask the provider to prescribe you an antianxiety medication.
• B. Would you like to discuss the procedure with your doctor once more?
• C. I think it would be nice to not have to worry about finding a bathroom.
• D. Would you like to speak with someone who has an ileal conduit?

Correct answer: D

Rationale: The most appropriate response for the nurse is to offer the client the opportunity to speak with someone who has undergone the same procedure. This allows the client to gain insight, ask questions, and share concerns with someone who has firsthand experience, which can help alleviate anxiety and promote a positive self-image. Seeking an antianxiety medication does not address the client's emotional concerns or promote a positive attitude towards the procedure. Discussing the procedure with the doctor again may provide more information but may not offer the same level of emotional support and understanding as speaking with someone who has lived through the experience. Commenting on the convenience of not having to search for a bathroom minimizes the client's anxiety and overlooks the emotional aspect of the client's concerns.

3. When planning care for a client newly diagnosed with open-angle glaucoma, the nurse identifies a priority nursing problem of 'visual sensory/perceptual alterations.' This problem is based on which etiology?

• A. Blurred distance vision
• B. Limited eye movement
• C. Decreased peripheral vision
• D. Photosensitivity

Correct answer: C

Rationale: The correct answer is 'C: Decreased peripheral vision.' Open-angle glaucoma leads to a gradual loss of peripheral vision due to damage to the optic nerve. This loss of peripheral vision is a hallmark sign of the condition and a primary reason for the visual sensory/perceptual alterations experienced by the client. Blurred distance vision (choice A) may occur but is not the priority nursing problem. Limited eye movement (choice B) and photosensitivity (choice D) are not typically associated with the sensory/perceptual alterations seen in open-angle glaucoma.

4. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to

• A. acquired bacterial resistance.
• B. cross-resistance.
• C. inherent bacterial resistance.
• D. transferred resistance.

Correct answer: A

Rationale: The correct answer is A: acquired bacterial resistance. Acquired resistance happens when an organism has been exposed to the antibacterial drug, making it less effective over time. Cross-resistance (B) occurs when resistance to one drug leads to resistance to another. Inherent resistance (C) happens without prior exposure to the drug, meaning the bacteria are naturally resistant. Transferred resistance (D) involves the transfer of resistant genes from one organism to another, contributing to resistance development.

5. A client is receiving a continuous IV infusion of heparin for the treatment of deep vein thrombosis. The client’s activated partial thromboplastin time (aPTT) level is 80 seconds. The client’s baseline before the initiation of therapy was 30 seconds. Which action does the nurse anticipate is needed?

• A. Shutting off the heparin infusion
• B. Increasing the rate of the heparin infusion
• C. Decreasing the rate of the heparin infusion
• D. Leaving the rate of the heparin infusion as is

Correct answer: C

Rationale: The nurse needs to decrease the rate of the heparin infusion. The therapeutic dose of heparin for the treatment of deep vein thrombosis is designed to keep the aPTT between 1.5 and 2.5 times normal. With the client's aPTT level elevated to 80 seconds from a baseline of 30 seconds, it indicates that the current rate of heparin infusion is too high. Lowering the rate of infusion is necessary to bring the aPTT within the desired therapeutic range. Choices A, B, and D are incorrect because shutting off the infusion, increasing the rate, or leaving it as is would not address the elevated aPTT level and may lead to complications.

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