Nursing Elites

1. While performing an inspection of a client's fingernails, the PN observes a suspected abnormality of the nail's shape and character. Which finding should the PN document?

• A. Clubbed nails
• B. Splinter hemorrhages
• C. Longitudinal ridges
• D. Koilonychia or spoon nails

Correct answer: A

Rationale: The correct answer is A: Clubbed nails. Clubbed nails are a significant finding often associated with chronic hypoxia or lung disease. The presence of clubbed nails should be documented for further evaluation. Splinter hemorrhages (Choice B) are tiny areas of bleeding under the nails and are associated with conditions like endocarditis. Longitudinal ridges (Choice C) are common and often a normal finding in older adults. Koilonychia or spoon nails (Choice D) refer to nails that are concave or scooped out, often seen in conditions like iron deficiency anemia or hemochromatosis. These conditions are not typically associated with chronic hypoxia or lung disease, making them less likely findings in this situation.

2. An older client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The PN notes that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the PN to implement?

• A. Ask family members to remain with the client in the evenings from 5 to 8 pm
• B. Administer a prescribed PRN benzodiazepine at the onset of a confused state
• C. Ensure that the client is assigned to a room close to the nurses' station
• D. Postpone administration of nighttime medications until after 11 pm

Correct answer: C

Rationale: Sundowning, a phenomenon where dementia symptoms worsen in the evening, can be managed by ensuring the client is close to the nurses' station for frequent monitoring and quick intervention, if necessary. This reduces the risk of harm and helps manage agitation. Asking family members to remain with the client may not always be feasible and does not address the need for close monitoring. Administering benzodiazepines should not be the first-line intervention for sundowning as it can increase the risk of falls and other adverse effects. Postponing medication administration may disrupt the client's routine and potentially worsen symptoms.

3. Which information should the nurse collect during the admission assessment of a terminally ill client to an acute care facility?

• A. Name of funeral home to contact
• B. Client's wishes regarding organ donation
• C. Contact information for the client's next of kin
• D. Healthcare proxy information

Correct answer: B

Rationale: During the admission assessment of a terminally ill client, it is crucial for the nurse to collect the client's wishes regarding organ donation. This information is vital to ensure that the care provided aligns with the client's values and preferences. Option A, 'Name of funeral home to contact,' is not a priority during the admission assessment and can be addressed later. Option C, 'Contact information for the client's next of kin,' is important but not as critical as understanding the client's wishes regarding organ donation. Option D, 'Healthcare proxy information,' is important for decision-making if the client is unable to make healthcare decisions, but knowing the client's wishes regarding organ donation takes precedence in this scenario.

4. A post-operative client is recovering from a total knee replacement and is prescribed patient-controlled analgesia (PCA). What is the primary advantage of PCA for managing post-operative pain?

• A. It allows for consistent pain control without overmedication.
• B. It eliminates the need for oral pain medication.
• C. It reduces the risk of opioid addiction.
• D. It requires less monitoring by nursing staff.

Correct answer: A

Rationale: The primary advantage of PCA for managing post-operative pain is that it allows the client to control the administration of pain medication, leading to consistent pain control without overmedication. Choice B is incorrect as PCA does not eliminate the need for oral pain medication; it supplements it. Choice C is incorrect because while PCA can help reduce opioid consumption, it does not directly reduce the risk of opioid addiction. Choice D is incorrect as PCA actually requires close monitoring by nursing staff to ensure proper use and prevent complications.

5. When caring for a child with sickle cell disease, the PN expects that the child will most likely describe which symptom when experiencing a sickle cell crisis?

• A. Decreased hemoglobin
• B. Joint pain
• C. Fatigue
• D. Infection

Correct answer: B

Rationale: During a sickle cell crisis, a child with sickle cell disease is most likely to describe joint pain. Sickle cell disease leads to the blockage of blood flow by sickled red blood cells, causing ischemia and pain, often felt in the joints and other body parts. Fatigue (choice C) is a nonspecific symptom that can occur in various conditions but is not a characteristic symptom of a sickle cell crisis. While decreased hemoglobin (choice A) can be observed in sickle cell disease, it is not a symptom typically described by a child during a sickle cell crisis. Infection (choice D) can trigger a sickle cell crisis but is not the symptom most likely to be described by the child during the crisis.

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