Nursing Elites

1. A 65-year-old female client is experiencing postmenopausal bleeding. Which type of physician should this client be encouraged to see?

• A. a radiologist
• B. a gynecologist
• C. a physiatrist
• D. an oncologist

Correct answer: B

Rationale: A 65-year-old female experiencing postmenopausal bleeding should be encouraged to see a gynecologist. Gynecologists specialize in treating and managing diseases of the female reproductive organs, making them the most appropriate physician for this issue. Postmenopausal bleeding can indicate various gynecological conditions such as endometrial atrophy, endometrial hyperplasia, or endometrial cancer, highlighting the importance of consulting a gynecologist for proper diagnosis and management. Radiologists evaluate X-rays, physiatrists manage rehabilitation teams, and oncologists treat clients with cancer. Therefore, in this case, the symptoms point towards a gynecological problem, emphasizing the necessity of seeking care from a gynecologist.

2. The client is being discharged with a prescription for an inhaled glucocorticoid for asthma. Which of the following statements indicates additional education is needed prior to discharge?

• A. "I will hold my breath for 10 seconds after each puff."?
• B. "I will wait five minutes after taking this medication and then gargle water."?
• C. "I will wait at least one minute between each puff."?
• D. "I will take this medication daily even if I am not having symptoms."?

Correct answer: B

Rationale: The correct answer is, 'I will wait five minutes after taking this medication and then gargle water.' After using an inhaled glucocorticoid, it is essential to wait for 5 minutes and then gargle water to remove any residue from the mouth, which can reduce the risk of developing thrush, a fungal infection. Choice A is correct as holding the breath for 10 seconds after each puff helps the medication reach deep into the lungs. Choice C is also correct as waiting at least one minute between puffs ensures proper delivery of the medication. Choice D is incorrect because it is important to take the medication daily as prescribed to control asthma symptoms, even if the person is not experiencing any at that moment.

3. A healthcare professional is using an otoscope to inspect the ears of an adult client. Which action does the professional take before inserting the otoscope?

• A. Pulling the pinna up and back
• B. Pulling the pinna down and forward
• C. Tipping the client's head down and toward the examiner
• D. Tipping the client's head down and away from the examiner

Correct answer: A

Rationale: In an adult client, the healthcare professional should pull the pinna up and back before inserting the otoscope. This action helps straighten the S shape of the ear canal, making it easier to insert the otoscope directly and comfortably. Tipping the client's head down and toward or away from the examiner is not the correct action when using an otoscope in an adult. Pulling the pinna down and forward is typically done when examining an infant or a child younger than 3 years old to straighten their ear canal for better visualization.

4. A nurse is preparing to auscultate for the presence of bowel sounds in a client who has just undergone surgery. The nurse places the stethoscope in which abdominal quadrant first?

• A. Left upper quadrant
• B. Left lower quadrant
• C. Right upper quadrant
• D. Right lower quadrant

Correct answer: D

Rationale: The correct answer is the right lower quadrant. The nurse starts auscultating in this quadrant at the ileocecal valve as bowel sounds are normally always present there. Then, the nurse proceeds to listen for bowel sounds in the other quadrants. Choices A, B, and C are incorrect as the initial placement of the stethoscope should be in the right lower quadrant to assess bowel sounds post-surgery.

5. Nurses caring for clients who have cancer and are taking opioids need to assess for all of the following except:

• A. tolerance.
• B. constipation.
• C. sedation.
• D. addiction.

Correct answer: D

Rationale: The correct answer is 'addiction.' When caring for clients with cancer who are taking opioids, nurses need to assess for tolerance, constipation, and sedation as these are common side effects of opioid use. Addiction is not a primary concern when managing pain in terminally ill clients, as the goal is effective pain management rather than addiction prevention. Tolerance refers to the body's adaptation to the opioid over time, requiring higher doses for the same effect. Constipation and sedation are common side effects of opioids that nurses need to monitor and manage. Addiction is not a major concern in this population as the focus is on providing comfort and pain relief.

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