Nursing Elites

1. A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active, and has no known risk factors for PE. What action by the nurse is most appropriate?

• A. Encourage the client to walk for 5 minutes each hour.
• B. Refer the client for smoking cessation classes.
• C. Teach the client about factor V Leiden testing.
• D. Explain to the client that sometimes no cause for the disease is found.

Correct answer: C

Rationale: The most appropriate action for the nurse in this scenario is to teach the client about factor V Leiden testing. Factor V Leiden is an inherited thrombophilia that can lead to abnormal clotting events, including pulmonary embolism (PE). In a case where a client has no known risk factors for PE, testing for this genetic disorder is crucial to determine if it is a contributing factor. Encouraging the client to walk or referring them to smoking cessation classes, while beneficial for overall health, are not directly relevant to the development of a PE in this specific case. While it is true that sometimes no cause for a disease is found, prematurely assuming this without appropriate investigations may lead to missed opportunities for preventive measures or treatments.

2. A healthcare professional is assessing a client who has a fracture of the femur. Vital signs are obtained on admission and again in 2 hours. Which of the following changes in assessment should indicate to the healthcare professional that the client could be developing a serious complication?

• A. Increased respiratory rate from 18 to 44/min
• B. Increased oral temperature from 36.6� C (97.8� F) to 37� C (98.6� F)
• C. Increased blood pressure from 112/68 to 120/72 mm Hg
• D. Increased heart rate from 68 to 72/min

Correct answer: A

Rationale: An increased respiratory rate from 18 to 44/min is a significant change that should alert the healthcare professional to a potential serious complication. Such a drastic increase in respiratory rate may indicate respiratory distress or hypoxia, which are critical conditions requiring immediate attention. The other options show minor changes in vital signs that are within normal limits and are less likely to indicate a serious complication.

3. The healthcare provider is caring for a client who has heart failure and a history of asthma. The provider reviews the orders and recognizes that clarification is needed for which of the following medications?

• A. Carvedilol
• B. Fluticasone
• C. Captopril
• D. Isosorbide dinitrate

Correct answer: B

Rationale: The correct answer is Fluticasone. Carvedilol, Captopril, and Isosorbide dinitrate are commonly used in heart failure management and do not typically pose significant risks for clients with a history of asthma. However, Fluticasone is a corticosteroid used to manage asthma but can potentially worsen heart failure symptoms due to its anti-inflammatory effects. Therefore, the nurse should seek clarification regarding the prescription of Fluticasone for a client with heart failure and a history of asthma.

4. A client has a three-chamber closed chest tube system, and the water seal chamber rises with client inspiration. What action should the nurse take?

• A. Continue to monitor the client.
• B. Immediately notify the healthcare provider.
• C. Reposition the client to the left side.
• D. Clamp the chest tube near the water seal.

Correct answer: A

Rationale: In a client with a three-chamber closed chest tube system, a rise in the water seal chamber with client inspiration is an expected finding. The nurse should continue to monitor the client as this indicates that the system is functioning correctly. There is no need to notify the healthcare provider, reposition the client, or clamp the chest tube as these actions are not indicated in response to a rise in the water seal chamber.

5. A client had a bronchoscopy 2 hours ago and asks for a drink of water. Which action should the nurse take next?

• A. Call the healthcare provider to request a prescription for food and water.
• B. Provide the client with ice chips instead of a drink of water.
• C. Assess the client's gag reflex before giving any food or water.
• D. Let the client have a small sip to assess swallowing ability.

Correct answer: C

Rationale: After a bronchoscopy, a topical anesthetic affects the gag reflex. Therefore, the nurse should assess the client's gag reflex before providing any food or water to ensure its return. This assessment is crucial to prevent aspiration or choking risk in the client.

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