Nursing Elites

1. A 24-year-old man seeks medical attention for complaints of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. What should the nurse check the client for next?

• A. Smoking history
• B. Recent exposure to allergens
• C. History of recent insect bites
• D. Familial tendency toward peripheral vascular disease

Correct answer: A

Rationale: In this case, the nurse should check the client's smoking history next. Smoking is a significant risk factor for peripheral vascular disease, leading to the development of thrombophlebitis and claudication. It is important to assess this risk factor as it can significantly impact the client's vascular health and the progression of their current symptoms. Choices B, C, and D are incorrect because they are not directly related to the symptoms described by the client. Recent exposure to allergens or insect bites would typically present with different symptoms, and familial tendency toward peripheral vascular disease is not the immediate concern in this case.

2. The nurse is reinforcing instructions to a client with coronary artery disease who is prescribed a low-cholesterol diet. The nurse should advise the client to choose which food item?

• A. Eggs and bacon
• B. Oatmeal with fresh fruit
• C. Cream of chicken soup
• D. Grilled cheese sandwich

Correct answer: B

Rationale: Oatmeal with fresh fruit is a suitable choice for a client with coronary artery disease on a low-cholesterol diet as it is low in cholesterol and provides heart-healthy benefits. Eggs and bacon, cream of chicken soup, and grilled cheese sandwich are higher in cholesterol and may not be as heart-healthy for this client. Eggs and bacon are high in cholesterol, cream of chicken soup may contain saturated fats, and a grilled cheese sandwich typically contains high amounts of fat and cholesterol, making them less suitable choices for a client with coronary artery disease on a low-cholesterol diet.

3. A client with a history of angina pectoris complains of substernal chest pain. The nurse checks the client's blood pressure and administers nitroglycerin 0.4 mg sublingually. Five minutes later, the client is still experiencing chest pain. If the blood pressure is still stable, what should the nurse do next?

• A. Administer another nitroglycerin tablet.
• B. Apply 1 to 3 L/minute of oxygen via nasal cannula.
• C. Call for a 12-lead electrocardiogram (ECG) to be performed.
• D. Wait an additional 5 minutes, then give a second nitroglycerin tablet.

Correct answer: A

Rationale: When a client with angina pectoris continues to experience chest pain despite initial nitroglycerin administration and stable blood pressure, the appropriate next step is to administer another nitroglycerin tablet. This helps to further dilate coronary arteries, improving blood flow to the heart muscle and relieving chest pain. Applying oxygen via nasal cannula (Choice B) may be necessary if the client displays signs of respiratory distress or hypoxemia, but in this case, the priority is addressing the unresolved chest pain. Calling for a 12-lead electrocardiogram (ECG) (Choice C) is important to assess for any changes in the client's cardiac status, but administering another nitroglycerin tablet takes precedence in managing the ongoing chest pain. Waiting an additional 5 minutes before giving a second nitroglycerin tablet (Choice D) may delay symptom relief and potentially worsen the client's condition if the chest pain persists.

4. A client with schizophrenia taking clozapine is being assessed by a nurse. Which of the following findings is the priority for the nurse to report to the provider?

• A. Elevated blood pressure
• B. Fever
• C. Weight gain
• D. Dry mouth

Correct answer: B

Rationale: The priority finding for the nurse to report to the provider is B: Fever. Fever can be an indication of agranulocytosis, a potentially life-threatening condition associated with clozapine. Agranulocytosis is characterized by a significant decrease in white blood cells, making the client susceptible to severe infections. Prompt reporting of fever is crucial to prevent serious complications. Elevated blood pressure (Choice A), weight gain (Choice C), and dry mouth (Choice D) are important to monitor but are not as immediately concerning as fever, which could indicate a severe adverse reaction requiring urgent medical attention.

5. The healthcare provider is setting up the bedside unit for a client being admitted to the nursing unit from the emergency department with a diagnosis of coronary artery disease (CAD). The provider should place the highest priority on making sure that which is available at the bedside?

• A. Bedside commode
• B. Rolling shower chair
• C. Oxygen tubing and flowmeter
• D. Twelve-lead electrocardiogram (ECG) machine

Correct answer: C

Rationale: In a client with coronary artery disease (CAD), ensuring the availability of oxygen and a flowmeter at the bedside is crucial. Oxygen is essential for adequate oxygenation, which helps prevent myocardial ischemia, a common complication in CAD. The other options, such as a bedside commode and rolling shower chair, are important for patient comfort and mobility but are not as critical as ensuring proper oxygen supply in a client with CAD. While having an ECG machine available is important for ongoing monitoring, ensuring oxygen availability takes precedence in this scenario.

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