Nursing Elites

1. A client is admitted with a diagnosis of left-sided heart failure. Which assessment finding is most consistent with this diagnosis?

• A. Dependent edema.
• B. Ascites.
• C. Nocturia.
• D. Orthopnea.

Correct answer: D

Rationale: Orthopnea (D) is most consistent with left-sided heart failure. It is characterized by difficulty breathing when lying flat and is relieved by sitting up or standing. Dependent edema (A), ascites (B), and nocturia (C) are more commonly associated with right-sided heart failure. Dependent edema refers to swelling due to fluid accumulation, ascites is the accumulation of fluid in the peritoneal cavity, and nocturia is the excessive need to urinate during the night, all of which are more indicative of right-sided heart failure.

2. The healthcare provider is preparing an older client for discharge. Which method is best for the provider to use when evaluating the client's ability to perform a dressing change at home?

• A. Determine the client's feelings about changing the dressing.
• B. Ask the client to write a description of the procedure.
• C. Have a family member evaluate the client's ability to change the dressing.
• D. Observe the client performing an unassisted dressing change.

Correct answer: D

Rationale: Direct observation of the client performing the skill is the most effective method to assess the client's ability to independently change the dressing. This allows the healthcare provider to evaluate the client's technique, understanding, and readiness to perform the task at home. Choices A, B, and C are not as reliable as directly observing the client performing the dressing change. Determining the client's feelings may not accurately reflect their ability, asking the client to write about the procedure may not demonstrate their practical skills, and having a family member evaluate might not provide an accurate assessment of the client's ability.

3. An older female client with rheumatoid arthritis is complaining of severe joint pain that is caused by the weight of the linen on her legs. What action should the nurse implement first?

• A. Apply flannel pajamas to provide warmth.
• B. Administer a PRN dose of ibuprofen.
• C. Perform range of motion exercises in a warm tub.
• D. Drape the sheets over the footboard of the bed.

Correct answer: D

Rationale: The correct answer is D. The nurse should first address the immediate comfort concern of the client, which is the weight of the linen on her legs causing severe joint pain. By draping the sheets over the footboard of the bed rather than tucking them under the mattress, the nurse can alleviate the pressure that the client perceives as the source of her pain. This action is a simple and effective way to provide relief and should be the initial step taken by the nurse. Choices A, B, and C do not directly address the client's immediate discomfort caused by the weight of the linen on her legs, making them less appropriate initial actions.

4. A client is admitted to the hospital with intractable pain. What instruction should the nurse provide the unlicensed assistive personnel (UAP) who is preparing to assist this client with a bed bath?

• A. Take measures to promote as much comfort as possible.
• B. Report any signs of drug addiction to the nurse immediately.
• C. Wait until the client's pain is gone before assisting with personal care.
• D. This client's pain will be difficult to manage, as the cause is unknown.

Correct answer: A

Rationale: The correct instruction for the unlicensed assistive personnel (UAP) preparing to assist a client with intractable pain is to take measures to promote as much comfort as possible. Intractable pain is resistant to relief, so ensuring comfort during all activities, including a bed bath, is crucial to enhance the client's well-being and quality of care.

5. A client with a diagnosis of coronary artery disease is receiving atorvastatin (Lipitor). Which laboratory test should the nurse monitor to evaluate the effectiveness of this medication?

• A. Complete blood count (CBC)
• B. Serum potassium level
• C. Liver function tests (LFTs)
• D. Serum cholesterol level

Correct answer: C

Rationale: To evaluate the effectiveness of atorvastatin (Lipitor), the nurse should monitor liver function tests (LFTs) (C) because this medication can impact liver function. Complete blood count (CBC) (A), serum potassium level (B), and serum cholesterol level (D) are not directly indicative of the medication's effectiveness in managing coronary artery disease.

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