Nursing Elites

1. The nurse has just received a change-of-shift report. Which client should the nurse assess first?

• A. A client 2 hours post-lobectomy with 150cc drainage
• B. A client 2 days post-gastrectomy with scant drainage
• C. A client with pneumonia with an oral temperature of 102�F
• D. A client with a fractured hip in Buck's traction

Correct answer: A

Rationale: The nurse should assess the client 2 hours post-lobectomy with 150cc drainage first because postoperative assessments are crucial during the immediate postoperative period. This client may be at higher risk for complications, such as bleeding or infection, requiring immediate attention. Clients in choices B, C, and D are relatively stable and can be assessed after the immediate postoperative client has been evaluated.

2. Support systems during the grieving process include all of the following except:

• A. a despondent friend.
• B. a nurse.
• C. a social worker.
• D. a family member.

Correct answer: B

Rationale: During the grieving process, it is essential to have a support system in place. Options B, C, and D - a nurse, a social worker, and a family member, respectively, are individuals who can provide comfort, guidance, and practical assistance to someone who is grieving. However, a despondent friend, as stated in the question, is not an ideal choice for support during this period. A despondent friend is someone who is feeling extremely unhappy and discouraged, and may not have the emotional capacity to provide the needed support to a grieving individual. It is important for someone who is grieving to have support from individuals who can offer understanding, empathy, and strength, which a despondent friend may struggle to provide.

3. When preparing a client for platelet pheresis in the blood bank, which information is most significant to obtain during the history assessment?

• A. Allergies to shellfish
• B. Date of last platelet donation
• C. Time of last oral intake
• D. Blood type

Correct answer: B

Rationale: The most significant information to gather when a client is scheduled for platelet pheresis is the date of their last platelet donation. Platelet donors can typically have their platelets apheresed as frequently as every 14 days. Knowing the date of the last donation helps ensure the client is eligible for the procedure without risking any adverse effects from frequent donations. Allergies to shellfish may be important for other procedures where anticoagulants containing heparin are used, but it is not directly related to platelet pheresis. The time of the last oral intake is more crucial for procedures requiring sedation or anesthesia. Blood type is significant for blood transfusions but is not the primary concern for platelet pheresis.

4. The client with obsessive-compulsive disorder (OCD) is asking for help with the repetitive behaviors. The nurse knows that these are a method of dealing with:

• A. Fearful situations
• B. Depression
• C. Delusions
• D. Anxiety

Correct answer: D

Rationale: The correct answer is D: Anxiety. Repetitive behaviors in OCD serve as a way for individuals to cope with their anxiety. These behaviors are often performed to reduce the distress caused by obsessive thoughts. Choice A, fearful situations, is incorrect because the behaviors are more related to managing anxiety rather than fear itself. Choice B, depression, is incorrect as OCD behaviors are not typically a method of coping with depression. Choice C, delusions, is also incorrect as these behaviors are not aimed at managing delusional thoughts but rather anxiety in OCD.

5. A client comes to the clinic for assessment of his physical status and guidelines for starting a weight-reduction diet. The client's weight is 216 pounds and his height is 66 inches. The nurse identifies the BMI (body mass index) as:

• A. Within normal limits, so a weight-reduction diet is unnecessary.
• B. Lower than normal, so education about nutrient-dense foods is needed.
• C. Indicating obesity because the BMI is 35.
• D. Indicating overweight status because the BMI is 27.

Correct answer: C

Rationale: Obesity is defined by a BMI of 30 or more with no co-morbid conditions. Body Mass Index (BMI) is calculated by utilizing a chart or nomogram that plots height and weight. In this case, the client's BMI is calculated as 35, indicating obesity. A BMI of 27 falls within the overweight range, not obesity (which starts at 30). Choices A and B are incorrect because a BMI of 35 indicates obesity, not normal limits or being lower than normal. Therefore, the correct answer is C, indicating obesity based on the BMI calculation.

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