Nursing Elites

1. When caring for a client with acute respiratory distress syndrome (ARDS), why does the nurse elevate the head of the bed 30 degrees?

• A. To reduce abdominal pressure on the diaphragm
• B. To promote retraction of the intercostal accessory muscles of respiration
• C. To promote bronchodilation and effective airway clearance
• D. To decrease pressure on the medullary center which stimulates breathing

Correct answer: A

Rationale: Elevating the head of the bed to 30 degrees is done to reduce abdominal pressure on the diaphragm, aiding in lung expansion and oxygenation. This position helps improve respiratory mechanics by allowing the diaphragm to move more effectively. Choice B is incorrect as elevating the head of the bed does not directly promote retraction of the intercostal accessory muscles of respiration. Choice C is incorrect because although elevating the head of the bed can assist with airway clearance, its primary purpose in ARDS is to decrease pressure on the diaphragm. Choice D is incorrect because reducing pressure on the medullary center is not the main goal of elevating the head of the bed; the focus is on enhancing lung function and oxygen exchange.

2. Before administering an intramuscular injection, the nurse's finger is stuck with the needle. Which action should the nurse take?

• A. Go to the emergency room to have blood drawn
• B. Prepare the medication using a new syringe
• C. Apply clean gloves before giving the medication
• D. Review the medical history in the client's chart

Correct answer: B

Rationale: In this scenario, if the nurse's finger is stuck with the needle before administering the injection, the correct action is to prepare the medication using a new syringe. This step is crucial to prevent contamination and ensure the safety of the patient. Going to the emergency room to have blood drawn is unnecessary and does not address the immediate issue of contamination. Applying clean gloves is important for infection control but does not address the potential contamination from the needlestick. Reviewing the medical history in the client's chart is important for overall patient care but is not the priority in this situation where immediate action is required to prevent harm.

3. The nurse implements a tertiary prevention program for type 2 diabetes in a rural health clinic. Which outcome indicates that the program was effective?

• A. Clients who developed disease complications promptly received rehabilitation
• B. More than 50% of at-risk clients were diagnosed early in their disease process
• C. Only 30% of clients did not attend self-management education sessions
• D. Average client scores improved on a specific risk factor knowledge test

Correct answer: A

Rationale: The correct answer is A because in tertiary prevention, the focus is on managing complications and providing rehabilitation. Choice B is more aligned with primary prevention as it focuses on early diagnosis. Choice C's attendance in education sessions is not a direct indicator of managing complications. Choice D's improvement in knowledge does not directly measure the program's effectiveness in managing complications.

4. After completion of mandatory counseling, the impaired nurse has asked nursing administration to allow return to work. When the nurse administrator approaches the charge nurse with the impaired nurse’s request, what action is best for the charge nurse to take?

• A. Ask to meet with the impaired nurse’s therapist before allowing the nurse back on the unit
• B. Meet with staff to assess their feelings about the impaired nurse’s return to the unit
• C. Since treatment is completed, assign the nurse to routine RN responsibilities
• D. Allow the impaired nurse to return to work and monitor medication administration

Correct answer: D

Rationale: Allowing the impaired nurse to return to work with monitoring is the best course of action in this scenario. By monitoring the impaired nurse's medication administration, the charge nurse can ensure safe practice while supporting the nurse's reintegration into the work environment. Meeting with the therapist (Choice A) is not within the charge nurse's scope of responsibility and may violate the impaired nurse's privacy. Assessing staff feelings (Choice B) is important but should be done by leadership, not the charge nurse. Simply assigning routine duties (Choice C) may not address the need for monitoring and support required in this situation.

5. A client who had a cerebrovascular accident (CVA) is paralyzed on the left side of the body and has developed a Stage II pressure ulcer on the left hip. Which nursing diagnosis describes this client’s current health status?

• A. Risk for impaired tissue integrity related to impaired physical mobility
• B. Impaired skin integrity related to altered circulation and pressure
• C. Ineffective tissue perfusion related to inability to move self in bed
• D. Impaired physical mobility related to the left-side paralysis

Correct answer: B

Rationale: The correct answer is B: 'Impaired skin integrity related to altered circulation and pressure.' This nursing diagnosis is the most appropriate as it directly addresses the Stage II pressure ulcer on the left hip, which is caused by altered circulation and pressure due to the client's left-side paralysis. Choice A is incorrect because it focuses on the risk for impaired tissue integrity rather than the current issue of impaired skin integrity. Choice C is incorrect as ineffective tissue perfusion is not the primary issue in this scenario. Choice D is incorrect as it only addresses the left-side paralysis and not the pressure ulcer or altered circulation.

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