Nursing Elites

1. A 65-year-old male client with a history of smoking and high cholesterol is admitted with shortness of breath and chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Pulmonary function tests (PFTs)

Correct answer: A

Rationale: The correct answer is an Electrocardiogram (ECG). An ECG should be performed first to assess for cardiac ischemia, especially given the client's symptoms and history. Chest X-ray (Choice B) may be ordered to evaluate the lungs but would not be the initial test for this client presenting with chest pain and shortness of breath. Arterial blood gases (ABGs) (Choice C) are used to assess oxygenation and acid-base balance but are not the primary diagnostic test for a client with suspected cardiac issues. Pulmonary function tests (PFTs) (Choice D) are used to assess lung function and would not be the first test indicated in this scenario.

2. A client with cirrhosis is admitted with ascites and jaundice. Which assessment finding is most concerning?

• A. Peripheral edema
• B. Confusion and altered mental status
• C. Increased abdominal girth
• D. Yellowing of the skin

Correct answer: B

Rationale: Confusion and altered mental status are concerning signs of hepatic encephalopathy in a client with cirrhosis. Hepatic encephalopathy is a serious complication of liver disease that requires immediate intervention. Peripheral edema may be present due to fluid accumulation, increased abdominal girth can indicate ascites which is common in cirrhosis, and yellowing of the skin is a typical manifestation of jaundice in liver dysfunction, all of which are important but not as immediately concerning as signs of hepatic encephalopathy.

3. The nurse is caring for a client with a history of atrial fibrillation who is prescribed warfarin (Coumadin). Which laboratory value should the nurse monitor closely?

• A. Prothrombin time (PT)
• B. Hemoglobin level
• C. International Normalized Ratio (INR)
• D. Serum sodium level

Correct answer: C

Rationale: The INR should be closely monitored in a client prescribed warfarin (Coumadin) to assess the effectiveness and safety of anticoagulation therapy. Monitoring the INR helps determine if the client's blood is clotting appropriately. While prothrombin time (PT) is related to warfarin therapy, the INR is a more precise measure. Hemoglobin level and serum sodium level are not directly related to monitoring warfarin therapy.

4. The nurse is caring for a client with a chest tube in place following a pneumothorax. Which assessment finding requires immediate intervention?

• A. Oxygen saturation of 94%
• B. Crepitus around the insertion site
• C. Subcutaneous emphysema
• D. Blood pressure of 110/70 mmHg

Correct answer: C

Rationale: Subcutaneous emphysema is the assessment finding that requires immediate intervention in a client with a chest tube following a pneumothorax. Subcutaneous emphysema can indicate a pneumothorax recurrence or air leak, which can compromise respiratory function and lead to serious complications. Oxygen saturation of 94% may be concerning but does not require immediate intervention as it is still within an acceptable range. Crepitus around the insertion site is common after chest tube placement and may not always indicate a problem. A blood pressure of 110/70 mmHg is within normal limits and does not require immediate intervention in this context.

5. The mother of an adolescent tells the clinic nurse, 'My son has athlete's foot. I have been applying triple antibiotic ointment for two days, but there has been no improvement.' What instruction should the nurse provide?

• A. Antibiotics take two weeks to become effective against fungal infections like athlete's foot.
• B. Continue using the ointment for a full week, even after the symptoms disappear.
• C. Applying too much ointment can reduce its effectiveness. Apply a thin layer to prevent maceration.
• D. Stop using the ointment and encourage complete drying of the feet and wearing clean socks.

Correct answer: D

Rationale: The correct answer is D. Athlete's foot (tinea pedis) is a fungal infection, not a bacterial infection that would respond to antibiotics. The primary management involves keeping the feet well-ventilated, dry after bathing, and wearing clean socks to prevent moisture buildup, which promotes fungal growth. Using an antibiotic ointment like triple antibiotic ointment is not effective for treating athlete's foot. Therefore, the nurse should advise the mother to stop using the antibiotic ointment and focus on promoting proper foot hygiene to manage the fungal infection. Choices A, B, and C are incorrect as they do not address the fungal nature of athlete's foot and the ineffectiveness of antibiotic ointments in its treatment.

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