Nursing Elites

1. Your patient had a stroke, or CVA, five years ago. The resident still has right-sided weakness. You are ready to transfer the resident from the bed to the wheelchair. The wheelchair should be positioned at the _____________.

• A. head of the bed on the patient's right side
• B. head of the bed on the patient's left side
• C. bottom of the bed on the patient's right side
• D. bottom of the bed on the patient's left side

Correct answer: B

Rationale: The wheelchair should be positioned at the head of the bed on the resident's left side. This positioning allows the resident to use their stronger left side to assist with the transfer, compensating for the right-sided weakness. Placing the wheelchair at the head of the bed on the patient's right side (Choice A) would not utilize the stronger left side, which is crucial for the transfer. Similarly, positioning the wheelchair at the bottom of the bed on either side (Choices C and D) would not facilitate optimal assistance from the resident's stronger side during the transfer process.

2. A client has become combative and is attempting to pull out his IV and take off his surgical dressings. The nurse receives an order to apply wrist restraints. Which action of the nurse signifies that restraints are being used safely?

• A. The nurse ties the restraints in a square knot to prevent the client from untying them
• B. The restraints are attached to a movable portion of the bed
• C. The padded side of the restraint is applied next to the skin of the wrist
• D. The nurse assesses the client's distal circulation every 24 hours

Correct answer: C

Rationale: Restraint use must prioritize the safety of the client. When applying restraints around the wrists, the padded side should be placed against the skin to help prevent skin breakdown. Additionally, restraints should be secured in quick-release knots to ensure they can be removed rapidly in case of an emergency. Choice A is incorrect as restraints should not be tied in a way that could prevent quick removal. Choice B is incorrect because restraints should not be attached to a movable part of the bed to avoid unintentional movement. Choice D is incorrect as assessing distal circulation is important but is not directly related to the safe application of restraints.

3. Which of the following activities would the nurse perform during the diagnosing phase of the nursing process? Select all that apply.

• A. Collect and organize client information
• B. Analyze data
• C. Identify problems, risks, and client strengths
• D. Develop nursing diagnoses

Correct answer: B

Rationale: During the diagnosing phase of the nursing process, the nurse analyzes the collected data to identify problems, risks, and client strengths, which then leads to developing nursing diagnoses. Collecting and organizing client information is part of the assessment phase, where data is gathered. Developing nursing diagnoses comes after data analysis in the diagnosing phase. Goal setting is a component of the planning phase, which follows the diagnosing phase.

4. Which of the following constitutes the five rights of medication administration?

• A. Right client, right nurse, right time, right dose, right route
• B. Right client, right time, right dose, right route, right order
• C. Right client, right drug, right dose, right time, right route
• D. Right physician, right nurse, right client, right drug, right dose

Correct answer: C

Rationale: The five rights of medication administration are essential to ensure safe and effective drug delivery to clients. The correct answer includes ensuring the right client receives the right drug at the right dose, via the right route, and at the right time. These elements are crucial to prevent medication errors and ensure optimal therapeutic outcomes. Choice A is incorrect as it includes 'right nurse' which is not part of the five rights of medication administration. Choice B is incorrect as it includes 'right order' which is not part of the five rights. Choice C is incorrect as it includes 'right drug' and 'right route', but it lacks 'right client' and 'right time'. Choice D is incorrect as it includes 'right physician' which is not part of the five rights.

5. The nurse is discussing the term subculture with a student nurse. Which statement by the nurse would best describe subculture?

• A. "Fitting as many people as possible into the majority culture."?
• B. "Identifying small groups of people who do not want to be identified with the larger culture."?
• C. "Singling out groups of people who suffer differential and unequal treatment as a result of cultural variations."?
• D. "Recognizing groups of people within a culture with shared characteristics that are not common to all members of the culture."?

Correct answer: D

Rationale: A subculture refers to a group of people within a larger culture who share distinct beliefs, values, or attitudes that are not universal among all members of the larger culture. Subcultures can emerge based on factors such as ethnicity, religion, education, occupation, age, and gender. The correct answer describes the concept of a subculture accurately. Choices A, B, and C are incorrect because they do not capture the essence of a subculture. Fitting people into the majority culture, identifying small groups who distance themselves from the larger culture, or singling out individuals facing differential treatment do not define subculture. Subcultures represent specific groups with shared characteristics that differentiate them from the broader cultural norms.

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