Nursing Elites

1. A client in the third trimester of pregnancy reports that she feels some 'lumpy places' in her breasts and that her nipples sometimes leak a yellowish fluid. She has an appointment with her healthcare provider in two weeks. What action should the nurse take?

• A. Instruct the client to immediately see her provider for an evaluation
• B. Assess the fluid for signs of infection
• C. Explain that this normal secretion can be assessed at the next visit
• D. Recommend breast ultrasound to rule out abnormalities

Correct answer: C

Rationale: The yellowish fluid is likely colostrum, a normal finding in late pregnancy as the breasts prepare for lactation. It is common for women in the third trimester to experience 'lumpy places' in the breasts due to increased milk duct development. In this situation, the nurse should educate the client that these findings are normal physiological changes associated with pregnancy. Since the client has an upcoming appointment with her healthcare provider in two weeks, it is appropriate to reassure her that this can be further assessed during that visit. Instructing the client to immediately see her provider (Choice A) is unnecessary as this is a common finding in late pregnancy. Assessing the fluid for signs of infection (Choice B) is not warranted as colostrum leakage is a normal occurrence. Recommending a breast ultrasound (Choice D) is premature without further assessment by the healthcare provider.

2. What is the expected outcome of prescribing a proton pump inhibitor to a client with a peptic ulcer?

• A. Promote healing of the gastric mucosa.
• B. Neutralize the effects of stomach acid.
• C. Inhibit the growth of Helicobacter pylori.
• D. Reduce gastric acid secretion.

Correct answer: D

Rationale: The correct answer is D: Reduce gastric acid secretion. Proton pump inhibitors (PPIs) work by reducing gastric acid secretion, which helps prevent further irritation of the gastric mucosa and allows ulcers to heal. While promoting healing of the gastric mucosa (Choice A) is an indirect outcome of reducing gastric acid secretion, the primary mechanism of PPIs is to lower acid levels. Choice B, neutralizing the effects of stomach acid, is typically associated with antacids, not PPIs. Inhibiting the growth of Helicobacter pylori (Choice C) is usually achieved with antibiotics, not PPIs.

3. A client with gastroesophageal reflux disease (GERD) is prescribed omeprazole. What is the primary purpose of this medication?

• A. Coat the lining of the stomach
• B. Neutralize stomach acid
• C. Promote gastric motility
• D. Reduce gastric acid secretion

Correct answer: D

Rationale: The correct answer is D: Reduce gastric acid secretion. Omeprazole is a proton pump inhibitor that works by reducing the production of gastric acid in the stomach. This helps in managing GERD by decreasing the acidity levels in the stomach. Choice A is incorrect because omeprazole does not coat the lining of the stomach. Choice B is incorrect as omeprazole does not neutralize stomach acid but rather reduces its production. Choice C is incorrect because omeprazole does not promote gastric motility; instead, it acts on acid secretion.

4. In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen reservoir bag does not deflate completely during inspiration and the client’s respiratory rate is 14 breaths/minute. What action should the nurse implement?

• A. Remove the mask immediately
• B. Document the assessment data
• C. Increase the oxygen flow
• D. Increase the respiratory rate setting

Correct answer: B

Rationale: The correct answer is to document the assessment data. In a partial rebreather mask, it is normal for the oxygen reservoir bag not to deflate completely during inspiration. Additionally, a respiratory rate of 14 breaths/minute falls within the normal range. Therefore, these findings indicate that the mask is functioning as intended. Removing the mask immediately is unnecessary as there are no signs of distress. Increasing the oxygen flow or adjusting the respiratory rate setting is not warranted based on the assessment findings, as they are within normal parameters.

5. After receiving a report on an inpatient acute care unit, which client should the nurse assess first?

• A. Client with pneumonia who has a fever of 101.5°F
• B. Client who underwent knee surgery and needs dressing change
• C. Client with a bowel obstruction due to a volvulus experiencing abdominal rigidity
• D. Client with diabetes requesting insulin

Correct answer: C

Rationale: The correct answer is C. Abdominal rigidity in a client with a bowel obstruction could indicate peritonitis, a serious complication requiring immediate attention. Volvulus, a twisting of the intestine, can lead to bowel ischemia and necrosis. Clients with pneumonia (choice A) may need assessment and treatment for infection, but it is not as immediately life-threatening as a bowel obstruction. A client who underwent knee surgery (choice B) needing a dressing change can typically wait for assessment compared to a potential surgical emergency. Similarly, a client with diabetes requesting insulin (choice D) may require attention to maintain blood glucose levels, but it is not as urgent as a suspected bowel obstruction with possible peritonitis.

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