Nursing Elites

1. The nurse is admitting a patient with an infectious disease process. Which question will be most appropriate for a nurse to ask about the patient's susceptibility to this infectious process?

• A. Do you have any children living in your home?
• B. Do you have a spouse?
• C. Do you have a chronic disease?
• D. Do you have any religious beliefs that will influence your care?

Correct answer: C

Rationale: The correct answer is C: 'Do you have a chronic disease?' Patients with chronic diseases are more susceptible to infections due to factors like general debilitation and nutritional impairment. Choices A, B, and D are incorrect because having children in the home, having a spouse, or religious beliefs do not directly impact susceptibility to infectious diseases.

2. A nurse is preparing to administer medications to four clients. The nurse should administer medications to which client first?

• A. A client who has pneumonia and a WBC count of 11,500/mm3 prescribed piperacillin
• B. A client who has renal failure and a serum potassium of 5.8 mEq/L prescribed sodium polystyrene sulfonate
• C. A client who is post-coronary artery bypass graft (CABG) prescribed atorvastatin
• D. A client who has anemia and a hemoglobin level of 11g/dL prescribed epoetin alfa

Correct answer: B

Rationale: The correct answer is B. The client with renal failure and high potassium levels requires immediate attention because hyperkalemia can lead to life-threatening cardiac complications. Administering sodium polystyrene sulfonate helps lower the potassium levels. Choice A, the client with pneumonia and a high WBC count, although important, does not present an immediate life-threatening condition. Choice C, the post-CABG client prescribed atorvastatin, and Choice D, the client with anemia and a hemoglobin level of 11g/dL prescribed epoetin alfa, do not require immediate intervention compared to managing hyperkalemia in a client with renal failure.

3. When educating a patient with hypertension about lifestyle changes, what is the most crucial advice to provide?

• A. Advise the patient to reduce salt intake.
• B. Instruct the patient to limit alcohol consumption.
• C. Recommend the patient to exercise for 30 minutes every day.
• D. Instruct the patient to avoid high-cholesterol foods.

Correct answer: A

Rationale: The most critical lifestyle change for a patient with hypertension is to reduce salt intake. Excessive salt consumption can lead to increased blood pressure levels. While limiting alcohol consumption (Choice B) and regular exercise (Choice C) are also beneficial for managing hypertension, reducing salt intake has a more direct impact on blood pressure control. Avoiding high-cholesterol foods (Choice D) is important for heart health but may not have as significant an impact on blood pressure as reducing salt intake.

4. The patient experienced a surgical procedure, and Betadine was utilized as the surgical prep. Two days postoperatively, the nurse's assessment indicates that the incision is red and has a small amount of purulent drainage. The patient reports tenderness at the incision site. The patient's temperature is 100.5°F, and the WBC is 10,500/mm³. Which action should the nurse take first?

• A. Reevaluate the temperature and white blood cell count in 4 hours.
• B. Check which solution was used for skin preparation in surgery.
• C. Plan to change the surgical dressing during the shift.
• D. Utilize SBAR to notify the primary health care provider.

Correct answer: D

Rationale: The patient is showing signs of a possible surgical site infection, including redness, purulent drainage, tenderness, elevated temperature, and increased white blood cell count. These symptoms suggest the need for immediate action to address a potential complication. Utilizing SBAR to notify the primary health care provider is crucial as it allows for effective communication of the patient's condition and the need for further assessment and intervention. Reevaluating the temperature and white blood cell count later, checking the solution used for skin preparation, or planning to change the dressing do not address the urgent need for intervention and communication with the healthcare provider.

5. What should be done to ensure safety during the transfer of a patient with limited mobility?

• A. Have the patient use a gait belt for support.
• B. Encourage the patient to hold onto a walker.
• C. Lock the wheels on the bed and wheelchair.
• D. Ask the patient to transfer independently.

Correct answer: C

Rationale: The correct answer is to lock the wheels on the bed and wheelchair. This action helps prevent accidents by stabilizing the equipment during the transfer process. Having the patient use a gait belt for support (choice A) can be helpful but is not directly related to equipment safety. Encouraging the patient to hold onto a walker (choice B) is beneficial for ambulation but does not address the safety of equipment. Asking the patient to transfer independently (choice D) can pose risks, especially for a patient with limited mobility, and may not ensure safety during the transfer.

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