Nursing Elites

1. A client with a history of hypertension 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. Pulmonary function tests (PFTs)
• D. Arterial blood gases (ABGs)

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG). An ECG should be performed first to assess for cardiac ischemia in a client presenting with shortness of breath and chest pain. This test helps in evaluating the electrical activity of the heart and can identify signs of myocardial infarction or other cardiac issues. Choice B, Chest X-ray, may be ordered after the ECG to assess for pulmonary conditions like pneumonia or effusions. Choice C, Pulmonary function tests (PFTs), are used to evaluate lung function and are not the primary diagnostic tests for a client with symptoms of cardiac origin. Choice D, Arterial blood gases (ABGs), may provide information about oxygenation but are not the initial test indicated for a client with suspected cardiac issues.

2. A 35-year-old female client has just been admitted to the post-anesthesia recovery unit following a partial thyroidectomy. Which statement reflects the nurse's accurate understanding of the expected outcome for the client following this surgery?

• A. Supplemental hormonal therapy will probably be unnecessary.
• B. The thyroid will regenerate to a normal size within a few years.
• C. The client will be restricted from eating seafood.
• D. The remainder of the thyroid will be removed at a later date.

Correct answer: C

Rationale: After a partial thyroidectomy, the client may be advised to avoid eating seafood due to its high iodine content, which can affect the thyroid function. Choice A is incorrect because after a partial thyroidectomy, supplemental hormonal therapy may be necessary. Choice B is incorrect as the thyroid does not regenerate after a partial thyroidectomy. Choice D is incorrect; the remaining portion of the thyroid is not typically removed at a later date unless there are specific medical reasons to do so.

3. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which assessment finding is most concerning?

• A. Bradycardia
• B. Muscle weakness
• C. Peaked T waves on the ECG
• D. Decreased deep tendon reflexes

Correct answer: C

Rationale: The correct answer is C: Peaked T waves on the ECG. In hyperkalemia, elevated potassium levels can affect the heart's electrical activity, leading to changes on the ECG such as peaked T waves. This finding is concerning as it can progress to serious cardiac arrhythmias, including ventricular tachycardia and fibrillation. Bradycardia (choice A) and decreased deep tendon reflexes (choice D) are not typically associated with hyperkalemia. While muscle weakness (choice B) can occur in hyperkalemia due to its effect on neuromuscular function, the most concerning assessment finding indicating the need for immediate intervention in this scenario is peaked T waves on the ECG.

4. The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which assessment finding is most concerning?

• A. Increased fatigue
• B. Headache
• C. Elevated blood pressure
• D. Low urine output

Correct answer: C

Rationale: In a client with chronic kidney disease (CKD) receiving erythropoietin therapy, an elevated blood pressure is the most concerning assessment finding. This finding can indicate worsening hypertension, which requires prompt intervention to prevent complications such as cardiovascular events or further kidney damage. Increased fatigue (Choice A) is a common symptom in CKD and can be expected with the condition itself or the treatment. Headache (Choice B) can also occur but is less specific to CKD or its treatment. Low urine output (Choice D) is a concern in CKD but may not be directly related to erythropoietin therapy.

5. A newly graduated female staff nurse requests reassignment to another client because a male client is asking her for a date and making suggestive comments. Which response is best for the nurse manager to provide?

• A. I have to call the supervisor to get someone else to transfer to this unit to care for him.
• B. I know you are a good nurse and can handle this client in a professional manner.
• C. I'll talk to the client about his behavior and insist that he stop it immediately.
• D. I'll change your assignment, but let's talk about how a nurse should respond to this kind of client.

Correct answer: D

Rationale: The best response for the nurse manager to provide in this situation is option D, which involves changing the assignment to address the nurse's immediate concern. It also offers an opportunity to have a conversation with the nurse about how to professionally handle such situations in the future. Option A is not the best response as it does not address the underlying issue and simply shifts the problem to another staff member. Option B, while supportive, does not actively address the client's inappropriate behavior. Option C is not ideal as the nurse manager should handle discussions about inappropriate behavior with clients themselves rather than delegating it to the staff nurse.

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