Nursing Elites

1. What is the correct way to assess for pitting edema?

• A. Press over the bony area for 5 seconds and release
• B. Press over the skin for 10 seconds and check for discoloration
• C. Press the area and check for the presence of rash
• D. Press the skin and assess for rebound tenderness

Correct answer: A

Rationale: The correct way to assess for pitting edema is to press over a bony area, typically the tibia, for 5 seconds and then release. This allows for the identification of pitting edema, characterized by an indentation that persists for a few seconds. Choice B is incorrect as pitting edema assessment does not involve checking for discoloration. Choice C is incorrect as the presence of a rash is not indicative of pitting edema. Choice D is incorrect as rebound tenderness is a different assessment used for abdominal conditions, not for pitting edema.

2. What are the common causes of postoperative pain and how should it be managed?

• A. Surgical incision and muscle tension
• B. Nerve damage and wound complications
• C. Hypotension and respiratory issues
• D. Infection at the incision site

Correct answer: A

Rationale: Postoperative pain is commonly caused by the surgical incision and muscle tension. The correct answer is A. Surgical incisions cause tissue damage, triggering pain responses. Muscle tension can result from factors like positioning during surgery or guarding due to pain. Managing postoperative pain caused by surgical incisions and muscle tension involves the use of analgesics to alleviate discomfort. Choices B, C, and D are incorrect. Nerve damage and wound complications may also cause pain but are not as common as surgical incisions and muscle tension. Hypotension and respiratory issues are not direct causes of postoperative pain. Infection at the incision site can lead to pain, but it is a specific complication rather than a common cause of postoperative pain.

3. What are the key components of a respiratory assessment?

• A. Inspection, Palpation, Percussion, Auscultation
• B. Inspection, Observation, Auscultation, Percussion
• C. Auscultation, Palpation, Observation, Percussion
• D. Observation, Palpation, Percussion, Auscultation

Correct answer: A

Rationale: The correct answer is A: Inspection, Palpation, Percussion, Auscultation. A focused respiratory assessment involves inspecting the chest for symmetry and signs of distress, palpating for tenderness or abnormal masses, performing percussion to assess underlying tissues, and auscultating lung sounds. Choice B is incorrect as observation is a broad term that can encompass both inspection and palpation. Choice C is incorrect as auscultation is usually performed after inspection and palpation. Choice D is incorrect as observation should be more specific, and auscultation is a key component that is typically done last in a respiratory assessment.

4. A client is using a metered-dose inhaler (MDI) for asthma management. Which of the following actions by the client indicates an understanding of the teaching?

• A. Inhale rapidly through the mouth after pressing down on the inhaler
• B. Exhale completely before pressing down on the inhaler
• C. Hold your breath for 5-10 seconds after inhaling
• D. Inhale slowly while pressing down on the inhaler

Correct answer: C

Rationale: The correct answer is to hold your breath for 5-10 seconds after inhaling when using a metered-dose inhaler (MDI) for asthma management. This action ensures proper medication absorption in the lungs. Inhaling rapidly (choice A) may cause the medication to impact the mouth/throat rather than the lungs. Exhaling completely before inhalation (choice B) does not optimize medication delivery. Inhaling slowly (choice D) may not allow the medication to reach the lungs effectively.

5. A nurse is caring for a client with a pressure ulcer and a serum albumin level of 3 g/dL. What should the nurse do first?

• A. Increase the client's protein intake
• B. Consult with a dietitian to improve the client's nutritional status
• C. Administer a protein supplement
• D. Monitor the client's fluid and electrolyte balance

Correct answer: B

Rationale: Consulting with a dietitian is the priority as it ensures that the client receives a comprehensive nutritional assessment and an individualized plan to address the low serum albumin level and pressure ulcer. Increasing protein intake (choice A) and administering a protein supplement (choice C) may be part of the dietitian's recommendations but should not be done without proper assessment and guidance. Monitoring fluid and electrolyte balance (choice D) is important but not the first step in addressing the client's nutritional needs.

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