Nursing Elites

1. What is the priority nursing action for a patient with confusion post-surgery?

• A. Administer oxygen
• B. Reposition the patient
• C. Check oxygen saturation
• D. Perform a neurological exam

Correct answer: A

Rationale: The correct answer is to administer oxygen. Post-surgery, confusion in a patient could be due to hypoxia, a condition where the body is deprived of an adequate oxygen supply. Administering oxygen helps address hypoxia promptly, improving oxygen levels in the body and potentially resolving the confusion. Repositioning the patient, checking oxygen saturation, and performing a neurological exam may be important interventions but addressing hypoxia with oxygen administration takes precedence as the priority action.

2. What is the best initial nursing intervention for a patient with suspected pulmonary embolism?

• A. Administer oxygen
• B. Administer anticoagulants
• C. Reposition the patient
• D. Check oxygen saturation

Correct answer: A

Rationale: Administering oxygen is the best initial nursing intervention for a patient with suspected pulmonary embolism because it helps address hypoxia, a common complication of this condition. Oxygen therapy can improve oxygenation and support vital organ function. Administering anticoagulants (Choice B) is a treatment option for confirmed pulmonary embolism but not the initial intervention. Repositioning the patient (Choice C) and checking oxygen saturation (Choice D) are important assessments but do not address the immediate need to improve oxygenation in a patient with suspected pulmonary embolism.

3. A nurse is assessing a client who is postoperative following a bowel resection. Which of the following findings should the nurse report to the provider?

• A. Heart rate 110/min.
• B. Temperature of 37.4°C (99.3°F).
• C. Respiratory rate of 18/min.
• D. Urine output of 20 mL/hr.

Correct answer: D

Rationale: A urine output of 20 mL/hr is below the expected range and indicates potential renal failure, requiring immediate intervention. In postoperative patients, a urine output less than 30 mL/hr suggests inadequate renal perfusion, a concern that needs prompt attention to prevent renal complications. The heart rate of 110/min, temperature of 37.4°C (99.3°F), and respiratory rate of 18/min are within normal ranges for a postoperative client and do not indicate immediate issues.

4. A nurse is teaching a prenatal class about infection prevention. Which of the following statements indicates an understanding of the teaching?

• A. I can visit someone with chickenpox 5 days after the sores crust.
• B. I should avoid cleaning my cat's litter box during pregnancy.
• C. I should wash my hands with hot water for 10 seconds after gardening.
• D. I can take antibiotics for viral infections.

Correct answer: B

Rationale: The correct answer is B because avoiding cleaning the cat's litter box during pregnancy reduces the risk of toxoplasmosis, which can be harmful to the developing fetus. Choice A is incorrect because visiting someone with chickenpox should be avoided as it is highly contagious. Choice C is incorrect as handwashing after gardening should involve soap and water, not just hot water, for effective infection prevention. Choice D is incorrect because antibiotics are ineffective against viral infections.

5. A nurse is caring for a client who has experienced a stroke and has aphasia. Which of the following communication strategies should the nurse use?

• A. Speak louder to help the client understand
• B. Speak using simple sentences and gestures
• C. Use a picture board to facilitate communication
• D. Have the client practice writing words down

Correct answer: C

Rationale: The correct answer is to use a picture board to facilitate communication. Aphasia can make it challenging for individuals to understand and use language. Using a picture board can help the client convey their needs and understand information more effectively. Speaking louder (A) may not be helpful as aphasia is not related to hearing loss. While speaking using simple sentences and gestures (B) can be beneficial, using a picture board (C) is a more concrete and visual method to support communication for individuals with aphasia. Having the client practice writing words down (D) may not be suitable if the client's expressive language skills are impaired due to aphasia.

Similar Questions