Nursing Elites

1. Which of the following ethnic groups is at highest risk in the United States for pesticide-related injuries?

• A. Native American
• B. Asian-Pacific
• C. Norwegian
• D. Hispanic

Correct answer: D

Rationale: The correct answer is 'Hispanic.' Hispanic individuals in the United States are at a higher risk for pesticide-related injuries due to their representation among migrant workers in agricultural settings. This exposure to pesticides in their work environments increases their risk compared to other ethnic groups. Choice A, 'Native American,' although indigenous populations may face environmental health disparities, the higher risk in this context is among Hispanic individuals. Choice B, 'Asian-Pacific,' and Choice C, 'Norwegian,' do not have the same level of exposure to pesticides as Hispanic migrant workers, making them less susceptible to pesticide-related injuries.

2. When a client with a major burn experiences body image disturbance, which of the following is an appropriate nursing intervention classification?

• A. grief work facilitation
• B. vital signs monitoring
• C. medication administration: skin
• D. anxiety reduction

Correct answer: A

Rationale: The correct answer is 'grief work facilitation' because it is a nursing intervention classification specifically designed to address disturbed body image in burn clients. The expected outcome of this intervention is grief resolution, which can help the client cope with the body image changes resulting from the burn. Choice B, 'vital signs monitoring,' is not the appropriate intervention for body image disturbance in burn clients. Vital signs monitoring is typically used for assessing physiological parameters like blood pressure, pulse rate, and temperature. Choice C, 'medication administration: skin,' is more focused on treating skin-related issues rather than addressing body image disturbance. It involves the administration of medications to promote skin healing and integrity. Choice D, 'anxiety reduction,' is aimed at managing anxiety in clients with major burns and is not specifically targeted at addressing body image disturbance. While anxiety may be a common emotional response to burns, the most appropriate intervention for body image disturbance in this scenario is 'grief work facilitation.'

3. Which action exemplifies the use of evidence-based practice in the delivery of client care?

• A. Advising a client to agree to the treatment recommended by their healthcare provider
• B. Taking a rectal temperature from a client for whom bleeding precautions have been instituted
• C. Donning sterile gloves to change an abdominal wound dressing
• D. Encouraging a client to take an herbal substance to treat their insomnia

Correct answer: C

Rationale: Evidence-based practice is an approach to client care where the nurse integrates the client’s preferences, clinical expertise, and the best research evidence to deliver quality care. Donning sterile gloves to change an abdominal wound dressing exemplifies evidence-based practice as it prevents the entrance of harmful bacteria into the wound, following best practice guidelines. The other options do not align with evidence-based practice. Advising a client to agree to a treatment does not involve integrating research evidence. Taking herbal substances may not be supported by strong research evidence and can pose risks. Additionally, rectal temperature-taking in a client with bleeding precautions can increase the risk of injury to the rectal mucosa, not aligning with best practices in care delivery.

4. A licensed practical nurse tells the certified nursing assistant (CNA) staff that they will need to comply with the mandatory overtime policy that the long-term care facility has implemented. Later that day, the nurse overhears a CNA complaining about the policy and telling other CNAs that she will not work the overtime if she has made other plans after her regular shift. What is the best approach for the nurse to use in dealing with the conflict?

• A. Providing a positive reward system for the CNA to encourage working the mandatory overtime
• B. Ignoring the complaints
• C. Avoiding assigning the CNA mandatory overtime
• D. Meeting with the CNA regarding her behavior concerning the overtime policy

Correct answer: D

Rationale: In this situation, the best approach for the nurse is to meet with the CNA regarding her behavior concerning the overtime policy. Initiating a discussion is crucial to address resistance by a staff member. A face-to-face meeting allows for the verbalization of feelings, identification of problems, and the opportunity to develop strategies to solve the issue. Ignoring the complaints and avoiding assigning mandatory overtime do not tackle the root of the problem. Providing a positive reward system might offer a temporary fix but does not directly address the resistance and conflict.

5. A client with cirrhosis of the liver presents with ascites. The physician is to perform a paracentesis. For safety, the nurse should ask the client to:

• A. drink 1000 cc of fluid prior to the procedure to aid in fluid loss.
• B. eat foods low in fat.
• C. empty his bladder prior to the procedure.
• D. assume the prone position.

Correct answer: C

Rationale: When performing a paracentesis, the client must be sitting up to allow the fluid to settle in the lower abdomen. To prevent trauma to the bladder while inserting a needle to aspirate the fluid, the bladder must be empty. Choice A is incorrect as excessive fluid intake can make the procedure more difficult due to increased abdominal distension. Choice B is unrelated to the procedure of paracentesis. Choice D is incorrect as the client should be sitting up, not in the prone position, during the procedure.

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