Nursing Elites

1. The HCP orders cultures of the urethral urine, bladder urine, and prostatic fluid. Which instructions would the nurse teach to achieve the first two (2) specimens?

• A. Collect the first 15 mL in one jar and then the next 50 mL in another
• B. Collect three (3) early morning, clean voided urine specimens
• C. Collect the specimens after the HCP massages the prostate
• D. Collect a routine urine specimen for analysis

Correct answer: A

Rationale: To obtain accurate cultures of urethral and bladder urine, the nurse should instruct the patient to collect the first 15 mL of urine in one container and the subsequent 50 mL in another. This method ensures that the specimens are separated appropriately for analysis. Choices B, C, and D are incorrect because collecting three early morning urine specimens, massaging the prostate, or collecting a routine urine specimen would not provide the specific separation of urethral and bladder urine required for this particular test.

2. What is the primary goal of care for a client diagnosed with sickle cell anemia?

• A. The client will call the healthcare provider if feeling ill.
• B. The client will be compliant with the medical regimen.
• C. The client will live as normal a life as possible.
• D. The client will verbalize understanding of treatments.

Correct answer: C

Rationale: The correct answer is C: 'The client will live as normal a life as possible.' For a client with sickle cell anemia, the primary goal of care is to promote a good quality of life by managing symptoms, preventing crises, and enhancing overall well-being. Option A is incorrect as it focuses on a specific action rather than the overall goal of care. Option B is important but not the primary goal; compliance is a means to achieve better health outcomes. Option D is also important but does not address the holistic approach of helping the client maintain a normal lifestyle despite their condition.

3. After undergoing a pericardiocentesis, which interventions should the nurse implement?

• A. Monitor vital signs every 15 minutes for the first hour
• B. Evaluate the client’s cardiac rhythm
• C. Record the amount of fluid removed as output
• D. All of the above

Correct answer: D

Rationale: Following a pericardiocentesis, it is crucial for the nurse to monitor vital signs regularly, evaluate cardiac rhythm, and record the amount of fluid removed as output to detect any complications promptly. These interventions help in ensuring the client's safety and detecting any potential issues early. Therefore, selecting 'All of the above' (Choice D) is the correct answer as it encompasses all the essential interventions required post-pericardiocentesis. Choices A, B, and C are necessary actions to provide comprehensive care and monitor the client effectively.

4. Interacting with the patient and their family to obtain subjective information is part of which of the following steps for determining and fulfilling the nursing care needs of the patient?

• A. Evaluation
• B. Planning
• C. Implementation
• D. Assessment

Correct answer: D

Rationale: The correct answer is D, Assessment. Assessment in nursing involves obtaining subjective information from the patient and their family to gather data about the patient's health status. This step is crucial as it helps identify the patient's needs, strengths, and areas requiring intervention. Choice A, Evaluation, is incorrect as evaluation comes after the implementation of the care plan to determine its effectiveness. Choice B, Planning, is also incorrect as it involves developing a plan of care based on the assessment data. Choice C, Implementation, is the phase where the nursing interventions are carried out based on the established care plan.

5. Which of the following statements does NOT apply to a nursing plan of care?

• A. It contains short-term goals
• B. It is developed by the patient's physician
• C. It must be continually evaluated
• D. It contains long-range goals

Correct answer: B

Rationale: The correct answer is B. A nursing plan of care is developed by the nursing staff, not the patient's physician. Choice A is correct as nursing plans of care typically include short-term goals to address immediate patient needs. Choice C is correct because nursing plans of care must be continually evaluated and adjusted based on the patient's progress. Choice D is incorrect as nursing plans of care can include both short-term and long-range goals to address the patient's overall health and well-being.

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