Nursing Elites

1. Twelve hours following a unilateral total knee replacement, a client reports being unable to sleep because of severe incisional pain. What is the best initial nursing action?

• A. Administer a prescribed sedative.
• B. Reposition the client for comfort.
• C. Apply ice packs to the surgical site.
• D. Instruct the client in the use of the prescribed patient-controlled analgesia (PCA) pump.

Correct answer: D

Rationale: Instructing the client in the use of the PCA pump is the best initial nursing action for managing severe incisional pain after knee replacement surgery. The PCA pump allows the client to self-administer pain medication effectively, promoting better pain management. Administering a sedative may mask the pain temporarily but doesn't address the root cause. Repositioning the client for comfort or applying ice packs may provide some relief but doesn't address the need for effective pain control as the PCA pump does.

2. The nurse is teaching a client about coronary artery disease (CAD) preventive health. Which behavior stated by the client indicates a need for additional information and teaching?

• A. Increasing physical activity.
• B. Eating a low-fat diet.
• C. Decreasing the number of cigarettes smoked per day.
• D. Monitoring blood pressure regularly.

Correct answer: C

Rationale: The correct answer is C. Decreasing the number of cigarettes smoked per day is not sufficient for CAD prevention. Smoking cessation is crucial in reducing the risk of CAD. While increasing physical activity, eating a low-fat diet, and monitoring blood pressure regularly are all positive behaviors for CAD prevention, quitting smoking should be emphasized due to its significant impact on cardiovascular health.

3. A client with chronic heart failure is experiencing dyspnea and has an oxygen saturation of 88%. Which position is most appropriate to improve oxygenation?

• A. Supine with legs elevated
• B. High Fowler's position
• C. Prone with pillows under the chest
• D. Side-lying with head flat

Correct answer: B

Rationale: The correct answer is B: High Fowler's position. High Fowler's position is the most appropriate for a client with chronic heart failure experiencing dyspnea and low oxygen saturation. This position helps improve lung expansion and oxygenation by maximizing chest expansion and allowing better ventilation. Choice A, supine with legs elevated, may worsen dyspnea by reducing lung expansion. Choice C, prone with pillows under the chest, is not suitable for a client experiencing dyspnea as it may further compromise breathing. Choice D, side-lying with head flat, does not facilitate optimal lung expansion and is not the best choice for improving oxygenation in this scenario.

4. An adult woman with primary Raynaud phenomenon develops pallor and then cyanosis of her fingers. After warming her hands, the fingers turn red, and the client reports a burning sensation. What action should the nurse take?

• A. Apply a cool compress to the affected fingers for 20 minutes
• B. Secure a pulse oximeter to monitor the client's oxygen saturation
• C. Report the finding to the healthcare provider as soon as possible
• D. Continue to monitor the fingers until the color returns to normal

Correct answer: D

Rationale: In primary Raynaud phenomenon, the fingers go through a color sequence of pallor, cyanosis, and then redness when warmed. The burning sensation reported by the client indicates reperfusion. Continuing to monitor the fingers until the color returns to normal is appropriate in this situation as it ensures that the symptoms are resolving without the need for further intervention. Applying a cool compress could exacerbate the symptoms by causing vasoconstriction. Securing a pulse oximeter to monitor oxygen saturation is not necessary in this case as the issue is related to vasospasm rather than oxygenation. Reporting the finding to the healthcare provider is not urgent unless there are signs of complications or the symptoms do not improve with warming.

5. A client with chronic kidney disease is advised to follow a low-phosphorus diet. Which food should the client avoid?

• A. Milk
• B. Apples
• C. Carrots
• D. Rice

Correct answer: A

Rationale: Correct Answer: Milk. Milk is high in phosphorus and should be avoided in a low-phosphorus diet for clients with chronic kidney disease. Choice B (Apples), C (Carrots), and D (Rice) are not significant sources of phosphorus and can be included in moderation in a low-phosphorus diet. Apples and carrots are generally considered healthy choices for most individuals, while rice is a staple food that is low in phosphorus and can be part of a renal diet.

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