Nursing Elites

1. Which of these nursing assessments would be the highest priority for a client at risk for aspiration pneumonia?

• A. Assessing the client's level of consciousness
• B. Monitoring the client's oxygen saturation
• C. Checking the client's gag reflex before eating or drinking
• D. Monitoring the client's intake and output

Correct answer: C

Rationale: Checking the client's gag reflex before eating or drinking is the highest priority for a client at risk for aspiration pneumonia. Aspiration pneumonia can occur when food, liquids, or saliva are inhaled into the lungs, leading to inflammation or infection. Checking the gag reflex helps prevent the aspiration of substances into the lungs. Assessing the client's level of consciousness (Choice A) is important but not as immediately critical as checking the gag reflex. Monitoring oxygen saturation (Choice B) is essential for respiratory assessment but does not directly prevent aspiration. Monitoring intake and output (Choice D) is important for overall client management but does not specifically address the risk of aspiration pneumonia.

2. The school nurse is teaching the faculty the most effective methods to prevent the spread of lice in the school. The information that would be most important to include would be which of these statements?

• A. The treatment requires reapplication in 8 to 10 days.
• B. Bedding and clothing can be boiled or steamed.
• C. Children are not to share hats, scarves, and combs.
• D. Nit combs are necessary to comb out nits.

Correct answer: C

Rationale: The most crucial information to prevent the spread of lice in schools is to avoid sharing hats, scarves, and combs. This is important as lice can easily spread through shared personal items. Choices A, B, and D are not as critical as choice C in preventing the spread of lice. Reapplication of treatment, boiling or steaming bedding and clothing, and using nit combs are important but not as crucial as avoiding the sharing of personal items.

3. When a client is receiving external beam radiation to the mediastinum for treatment of bronchial cancer, which of the following should take priority in planning care?

• A. Esophagitis
• B. Leukopenia
• C. Fatigue
• D. Skin irritation

Correct answer: B

Rationale: Leukopenia should take priority in planning care for a client receiving external beam radiation to the mediastinum for bronchial cancer because it is a serious side effect that increases the risk of infection. Monitoring leukopenia is crucial to prevent complications. Esophagitis, fatigue, and skin irritation are also potential side effects of radiation therapy, but leukopenia poses a higher risk of life-threatening infections, requiring immediate attention.

4. A client wants to increase her daily intake of omega-3 fatty acids. Which of the following foods should the nurse suggest the client increase?

• A. Blueberries
• B. Soybean oil
• C. Citrus fruits
• D. Green tea

Correct answer: B

Rationale: The correct answer is B: Soybean oil. Soybean oil is a good source of omega-3 fatty acids, which are beneficial for heart health. Blueberries (choice A), citrus fruits (choice C), and green tea (choice D) are not significant sources of omega-3 fatty acids. Blueberries are rich in antioxidants, citrus fruits provide vitamin C, and green tea contains polyphenols, but they do not offer a substantial amount of omega-3 fatty acids compared to soybean oil.

5. A 20-year-old client has an infected leg wound from a motorcycle accident and has returned home from the hospital. The client is to keep the affected leg elevated and is on contact precautions. The client wants to know if visitors can come. The appropriate response from the home health nurse is that:

• A. Visitors must wear a mask and a gown
• B. There are no special requirements for visitors of clients on contact precautions
• C. Visitors should wash their hands before and after touching the client
• D. Visitors -

Correct answer: C

Rationale: The correct answer is C: 'Visitors should wash their hands before and after touching the client.' When a client is on contact precautions, it is essential for visitors to practice good hand hygiene to prevent the spread of infection. While wearing a mask and a gown might be necessary for healthcare providers, it is not typically required for visitors. Option B is incorrect because there are indeed special requirements for visitors on contact precautions, including practicing good hand hygiene. Option D is incomplete and does not provide any guidance on infection prevention measures.

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