A scrub nurse preparing for the first surgery of the day asks if a 3-minute surgical hand scrub is adequate. What should the circulating nurse advise?

Correct Answer: B

Rationale: In the context of the HESI RN Exit Exam Capstone, understanding the importance of surgical hand scrub duration is crucial for maintaining aseptic technique and preventing surgical site infections. The correct answer, B) Extend scrub time to 5 minutes, is based on evidence-based practice guidelines that recommend a 5-minute scrub to effectively reduce microbial flora on the hands prior to surgery. Option A) Proceed with surgery preparation is incorrect because a 3-minute scrub is not considered sufficient to adequately reduce the microbial flora on the hands. Option C) Use an alcohol-based hand sanitizer is also incorrect because while alcohol-based sanitizers are effective in certain situations, they are not a substitute for a thorough surgical hand scrub before surgery. Option D) Scrub time depends on the type of surgery is incorrect because regardless of the type of surgery, a 5-minute hand scrub is generally recommended to ensure proper hand hygiene practices are followed consistently. Educationally, this question highlights the importance of adhering to evidence-based guidelines in healthcare settings to promote patient safety and prevent healthcare-associated infections. Understanding and following proper hand hygiene protocols is a fundamental aspect of nursing practice that directly impacts patient outcomes and quality of care.

Correct Answer: D

Rationale: The correct follow-up question for the nurse to ask in this scenario is "D) Have you had recent cold intolerance or unusual fatigue?" This question is most appropriate because the client's symptoms (coarse hair, eyebrow changes, puffy eyes) are indicative of hypothyroidism, a condition where the thyroid gland is underactive. Cold intolerance and unusual fatigue are common symptoms of hypothyroidism, so asking about these can provide valuable information for further assessment and potential diagnosis. Option A) "Have you noticed any changes in your fingernails?" is less relevant in this context as changes in the nails are not specific to thyroid dysfunction. Option B) "Have you had any changes in weight or energy levels?" While weight gain and low energy can be seen in hypothyroidism, they are not as specific to the symptoms described by the client. Option C) "Do you have a family history of thyroid problems?" While family history can be important in assessing risk factors for thyroid disorders, the client's current symptoms are more indicative of her own thyroid status rather than her family history. In an educational context, it is crucial for nurses to understand the importance of thorough assessment and the relevance of specific questions based on presenting symptoms. This question highlights the need for critical thinking in connecting symptoms to potential underlying conditions, demonstrating the importance of holistic care and assessment in nursing practice.

Correct Answer: C

Rationale: In this scenario, the assessment finding that warrants immediate intervention by the nurse is option C) Round and tight abdomen. This finding indicates a potential complication of ascites, such as abdominal compartment syndrome, which can lead to impaired circulation, respiratory compromise, and even organ failure. Immediate intervention is crucial to prevent further deterioration of the client's condition. Option A) Capillary refill of 8 seconds is a concerning finding but is not as critical as a round and tight abdomen in this context. It may indicate issues with perfusion, but it does not directly address the immediate threat posed by a tense abdomen. Option B) Bruises on arms and legs may suggest a bleeding disorder or trauma but do not directly address the urgent issue of a round and tight abdomen. Option D) Pitting edema in lower legs is a common finding in clients with ascites and may be related to fluid retention, but it does not indicate the same level of urgency as a tense abdomen. Educationally, understanding the significance of different assessment findings in clients with ascites is crucial for nurses caring for these patients. Recognizing the signs of complications like abdominal compartment syndrome and knowing when to intervene promptly can help prevent adverse outcomes and improve patient care.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Severe tenderness and guarding. When the gallbladder is inflamed, it typically results in acute cholecystitis, which presents with severe tenderness and guarding upon palpation. This is due to the inflammation of the gallbladder wall, causing localized pain and sensitivity to touch. Option B) Slight discomfort upon palpation is incorrect because inflammation of the gallbladder usually elicits more than just slight discomfort. The severity of the tenderness is typically more pronounced in cases of cholecystitis. Option C) A sensation of fullness is incorrect because a sensation of fullness is not a characteristic finding associated with an inflamed gallbladder. The key feature is tenderness and guarding due to the inflammatory process. Option D) No symptoms unless the gallbladder is extremely inflamed is incorrect because even mild inflammation of the gallbladder can present with symptoms such as tenderness and guarding upon palpation. Educationally, understanding the signs and symptoms of gallbladder inflammation is crucial for nurses to assess and intervene promptly, especially in patients with risk factors for gallbladder disease. Recognizing the specific manifestations of gallbladder inflammation helps in timely diagnosis and treatment to prevent complications such as gallbladder rupture or infection.

Correct Answer: B

Rationale: In the context of starting a screening program for hypothyroidism, the nurse should consider beginning at an African-American senior citizens' center (Option B) for several reasons. Firstly, hypothyroidism is more prevalent among older adults, making a senior citizens' center a suitable location for screening. African-Americans also have a higher risk of developing hypothyroidism compared to other ethnic groups, further supporting the choice of this demographic. Additionally, older adults may have limited access to healthcare services and may benefit from on-site screenings. Options A, C, and D are not ideal choices for starting a screening program for hypothyroidism. A business and professional women's group (Option A) may not represent a demographic with a high prevalence of hypothyroidism. Similarly, a daycare center in a Hispanic neighborhood (Option C) and an after-school center for Native American teens (Option D) cater to populations that are not typically at high risk for hypothyroidism. From an educational perspective, this question highlights the importance of considering demographic factors and prevalence rates when planning health screening programs. It emphasizes the need for targeted and strategic approaches to healthcare interventions, especially when dealing with conditions that disproportionately affect specific populations. Nurses and healthcare providers must be knowledgeable about epidemiological data and cultural considerations to effectively address community health needs.