Nursing Elites

1. What is the appropriate nursing intervention for a patient with suspected deep vein thrombosis (DVT)?

• A. Administer anticoagulants
• B. Encourage ambulation
• C. Apply compression stockings
• D. Monitor oxygen saturation

Correct answer: A

Rationale: The correct answer is to administer anticoagulants. Anticoagulants help prevent further clot formation in patients with suspected DVT. Encouraging ambulation can be beneficial in preventing DVT but is not the immediate intervention for a suspected case. Compression stockings are more for DVT prevention rather than treatment. Monitoring oxygen saturation is important in assessing respiratory function but is not the primary intervention for suspected DVT.

2. A nurse overhears two assistive personnel (AP) discussing care for a client in the elevator. What action should the nurse take?

• A. Contact the client's family about the incident.
• B. Notify the client's provider about the incident.
• C. File a complaint with the ethics committee.
• D. Report the incident to the AP's charge nurse.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to report the incident to the AP's charge nurse. This ensures that the issue is addressed internally and allows for proper handling of the situation. Contacting the client's family about the incident (Choice A) may not be appropriate as it could breach confidentiality and escalate the situation unnecessarily. Notifying the client's provider (Choice B) is not the most immediate and effective step to address the issue. Filing a complaint with the ethics committee (Choice C) should be reserved for serious ethical violations, and in this case, reporting to the charge nurse is the more practical and immediate course of action.

3. A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include?

• A. Resume a regular diet immediately.
• B. Remove the adhesive bandage after 3 days.
• C. Begin moderate activity immediately.
• D. Take a tub bath instead of a shower.

Correct answer: B

Rationale: The correct answer is B. The adhesive bandage should be removed 3 days after a laparoscopic cholecystectomy to allow the incision to heal properly. Choice A is incorrect as the client should start with a clear liquid diet and advance to a regular diet as tolerated. Choice C is incorrect because the client should gradually increase activity levels as tolerated. Choice D is incorrect as the client should avoid tub baths and opt for showers to prevent infection and promote healing.

4. A client with lactose intolerance and has eliminated dairy products from his diet should increase consumption of which of the following foods?

• A. Spinach
• B. Peanut butter
• C. Ground beef
• D. Carrots

Correct answer: A

Rationale: Spinach is the correct answer because it is a good source of calcium. Since the client has eliminated dairy products due to lactose intolerance, which are a common source of calcium, increasing spinach consumption can help compensate for the lost calcium. Peanut butter, ground beef, and carrots are not significant sources of calcium and therefore not the best choice for this client.

5. A nurse is caring for a client who has Raynaud's disease. Which of the following actions should the nurse take?

• A. Provide information about stress management.
• B. Maintain a warm temperature in the client's room.
• C. Administer epinephrine for acute episodes.
• D. Give glucocorticoid steroids twice a day.

Correct answer: A

Rationale: Corrected Rationale: Providing information about stress management is essential when caring for a client with Raynaud's disease because stress can trigger episodes. Stress management techniques can help the client avoid triggers and reduce the frequency of episodes. Choice B is incorrect because maintaining a warm temperature, rather than a cool one, helps prevent vasoconstriction and can be beneficial for clients with Raynaud's disease. Choice C is incorrect because epinephrine is not a standard treatment for Raynaud's disease; it is more commonly used for severe allergic reactions. Choice D is incorrect because glucocorticoid steroids are not typically used in the management of Raynaud's disease.

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