Nursing Elites

1. What are the key nursing interventions for a patient with a tracheostomy?

• A. Maintain a patent airway and monitor for infection
• B. Suction airway secretions and provide humidified oxygen
• C. Educate patient on self-care and tracheostomy cleaning
• D. Change tracheostomy ties daily

Correct answer: A

Rationale: The correct answer is to maintain a patent airway and monitor for infection. These are crucial nursing interventions for patients with tracheostomies to ensure adequate oxygenation and prevent complications. Suctioning airway secretions and providing humidified oxygen can be part of the care plan but are not as essential as maintaining a patent airway. Educating the patient on self-care and tracheostomy cleaning is important for long-term management but is not as immediate as ensuring a patent airway and monitoring for infection. Changing tracheostomy ties daily is a specific task related to tracheostomy care but is not as critical as ensuring the airway is clear and infection-free.

2. A nurse at a long-term care facility is part of a team preparing a report on the quality of care at the facility. Which of the following information should the nurse recommend including in the report to demonstrate improvement in care quality?

• A. Increased admissions
• B. 12% fewer urinary tract infections
• C. Increased mortality rate
• D. No changes in staffing

Correct answer: B

Rationale: The correct answer is B: '12% fewer urinary tract infections.' Tracking infections, such as UTIs, is crucial in assessing care quality improvements as the reduction in infections indicates better infection control practices and overall quality of care. Choices A, C, and D are incorrect. Increased admissions (Choice A) do not directly reflect improvements in care quality. Increased mortality rate (Choice C) is a negative outcome and demonstrates a decline in care quality. No changes in staffing (Choice D) do not provide direct evidence of care quality improvements.

3. A client with type 2 diabetes mellitus is being taught about insulin administration by a nurse. Which of the following instructions should the nurse include?

• A. Inject insulin into the muscle
• B. Rotate injection sites with each dose
• C. Store insulin at room temperature
• D. Massage the injection site after administration

Correct answer: B

Rationale: The correct instruction that the nurse should include is to rotate injection sites with each dose. This practice is essential to prevent tissue damage and ensure proper insulin absorption. Option A is incorrect because insulin should not be injected into the muscle, but rather into the subcutaneous tissue. Option C is incorrect as insulin should be stored in the refrigerator to maintain its effectiveness. Option D is incorrect as massaging the injection site after administration can lead to faster absorption and potentially hypoglycemia.

4. A nurse is teaching a client how to administer enoxaparin. Which of the following instructions should the nurse include?

• A. Inject the medication into the muscle of the thigh
• B. Massage the injection site after administration
• C. Pinch the skin before injecting
• D. Administer the medication at the same time each day

Correct answer: C

Rationale: The correct instruction for administering enoxaparin is to pinch the skin before injecting. Pinching the skin helps create a proper fold for subcutaneous injections like enoxaparin, ensuring proper delivery of the medication into the subcutaneous tissue. Choice A is incorrect because enoxaparin should be administered subcutaneously, not into the muscle. Injecting it into the muscle can lead to complications. Choice B is incorrect because massaging the injection site after administration can increase the risk of bleeding or bruising due to the anticoagulant properties of enoxaparin. Choice D is incorrect as it is a general instruction and does not specifically relate to the administration of enoxaparin.

5. What are the signs of hypoglycemia, and how should a healthcare provider respond to a patient experiencing this condition?

• A. Shakiness or Tremors
• B. Confusion or Irritability
• C. Hunger
• D. Dizziness or Lightheadedness

Correct answer: A

Rationale: The signs of hypoglycemia include shakiness, confusion, hunger, dizziness, and lightheadedness. However, the classic and most common early sign is shakiness or tremors. When a patient is experiencing hypoglycemia, a healthcare provider should respond promptly by administering glucose to raise the blood sugar levels. Choice A is correct as it directly addresses one of the primary signs of hypoglycemia. Choices B, C, and D are incorrect because while confusion, irritability, hunger, dizziness, and lightheadedness can also be signs of hypoglycemia, shakiness or tremors are the classic and most common early symptoms that healthcare providers should be particularly vigilant for.

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