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. What complication of wound healing is an abnormal passage that connects two body cavities or a cavity and the skin?

• A. Fistula
• B. Hemorrhage
• C. Evisceration
• D. infection

Correct answer: A

Rationale:

3. What is the priority nursing diagnosis after surgery to repair a fracture?

• A. Disturbed body image
• B. Risk for infection
• C. Risk for impaired skin integrity
• D. Acute pain

Correct answer: B

Rationale: The correct answer is B: Risk for infection. After surgery to repair a fracture, the priority nursing diagnosis is to monitor for the risk of infection to promote proper healing. Infections can significantly delay the healing process and lead to further complications. Choices A, C, and D are not the priority immediately post-surgery. Disturbed body image, risk for impaired skin integrity, and acute pain may be concerns but are not the priority in the immediate post-operative period following fracture repair.

4. What observation by the nurse indicates the need for further teaching to unlicensed assistive personnel (UAP) on assisting with ambulation?

• A. The UAP puts shoes on the client
• B. The UAP removes floor rugs and loose objects from the path
• C. The UAP walks to the side and slightly in front of the client
• D. The UAP uses a transfer (gait) belt

Correct answer: C

Rationale: Choice C is the correct answer because the UAP should walk slightly behind or to the side of the client, not in front, to provide proper support during ambulation. Choices A, B, and D are not indicative of incorrect technique or the need for further teaching. Putting shoes on the client, removing floor rugs and loose objects, and using a transfer (gait) belt are all appropriate actions when assisting with ambulation.

5. 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:

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