Nursing Elites

1. The nurse will be using the Braden Scale with each admit to the long-term care center. Which of these will NOT be utilized in a Braden Scale Assessment?

• A. Mental state
• B. Friction and shear
• C. Nutrition
• D. Sensory perception

Correct answer: A

Rationale:

2. Which of the following statements by a client with human immunodeficiency virus (HIV) does NOT requires further teaching?

• A. I can spread this through contact with surfaces, so I need to wear gloves in public.'
• B. Because I have HIV, that means I'm an AIDS patient'
• C. I need to ensure that I place my needles in a proper needle disposal container.'
• D. I can still have unprotected intercourse with my partner since he does not have HIV.'

Correct answer: C

Rationale:

3. The nurse suspects a 3-year-old who is coughing vigorously has aspirated a small object. Which action should the nurse take?

• A. Deliver upward abdominal thrusts with a fisted hand
• B. Perform a blind finger sweep of the child's mouth
• C. Complete five rapid back blows between the shoulder blades
• D. Encourage the child to continue coughing

Correct answer: D

Rationale:

4. What is a symptom of the expected disease pattern of rheumatoid arthritis?

• A. Unilateral joint pain
• B. Bilateral joint pain
• C. Contralateral joint pain
• D. Obtuse variety joint pain

Correct answer: B

Rationale:

5. A client has sustained an open fracture. What nursing intervention will best prevent osteomyelitis in this client?

• A. Delegate all client personal care to specific unlicensed assistive personnel
• B. Place the client in contact precautions
• C. Proper hand hygiene
• D. Administer pain medication

Correct answer: C

Rationale: Proper hand hygiene is crucial in preventing infections such as osteomyelitis in clients with open fractures. Keeping the hands clean helps reduce the risk of introducing harmful pathogens to the wound site. Delegating all client personal care to specific unlicensed assistive personnel (Choice A) is not appropriate as direct involvement in wound care is essential in preventing infections. Placing the client in contact precautions (Choice B) is not directly related to preventing osteomyelitis in this context. Administering pain medication (Choice D) is important for managing the client's pain but does not directly address the prevention of osteomyelitis.

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