Nursing Elites

1. The nurse is assessing a client who had a cast placed 4 hours ago. What assessment finding is cause for concern?

• A. The nurse assesses capillary refill of 2 seconds
• B. The nurse cannot insert one finger between the cast and the skin
• C. The nurse finds 2+ pulses distal from the cast
• D. The nurse does not observe any drainage

Correct answer: B

Rationale: Inability to insert a finger between the cast and skin indicates the cast is too tight, risking circulation problems.

2. What nursing intervention is best to improve communication with a hearing-impaired client?

• A. Speak slowly and clearly while facing the client
• B. Write down the message
• C. Talk in a regular voice in the good ear
• D. Shout in the impaired

Correct answer: A

Rationale: Speaking slowly and clearly while facing the client improves communication with hearing-impaired clients.

3. What is a sign of inadequate perfusion?

• A. Intact sensation
• B. Pallor in toes
• C. Bounding pulses
• D. Pink fingers

Correct answer: B

Rationale:

4. The medical record for a client states that the client has hemiplegia. What does this mean?

• A. The client can use his right arm, left leg, and left arm.
• B. The client has paralysis of all four extremities.
• C. The client has decreased vision in one eye.
• D. The client has paralysis on one side of the body.

Correct answer: D

Rationale: Hemiplegia refers to paralysis on one side of the body, affecting either the right or left side. Choice A is incorrect because it describes selective paralysis of specific limbs, not one side of the body. Choice B is incorrect as hemiplegia does not involve paralysis of all four extremities. Choice C is also incorrect as decreased vision in one eye is not indicative of hemiplegia.

5. A client with a bone cancer states that he is in too much pain to walk today. What should the nurse do first?

• A. Inquire about the frequency, quality and location of the pain
• B. Get the client pain medication
• C. Ensure the client knows he will have negative effects from immobility
• D. Review the client’s medication administration record

Correct answer: A

Rationale: Assessing the pain characteristics helps in managing the client’s pain effectively.

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