Nursing Elites

1. A client with a history of myocardial infarction is admitted with 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. Echocardiogram

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG). An electrocardiogram should be performed first to assess for cardiac ischemia in a client with a history of myocardial infarction and chest pain. This test provides immediate information about the heart's electrical activity. Choice B, Chest X-ray, is used to visualize the structures of the chest, including the heart and lungs, but it does not directly assess for cardiac ischemia. Choice C, Arterial blood gases (ABGs), measures the oxygen and carbon dioxide levels in the blood and assesses acid-base balance, which is not the primary concern in this scenario. Choice D, Echocardiogram, is an ultrasound of the heart that provides information about the heart's structure and function, but it is not the initial diagnostic test for assessing cardiac ischemia in this situation.

2. The parents of a 6-year-old recently diagnosed with asthma should be taught that symptoms of an acute episode of asthma are due to which physiological response?

• A. Inflammation of the mucous membrane and bronchospasm
• B. Increased mucus production and airway obstruction
• C. Hyperinflation of the lungs and alveolar collapse
• D. Bronchoconstriction and airway inflammation

Correct answer: D

Rationale: The correct answer is D: Bronchoconstriction and airway inflammation. During an acute asthma episode, bronchoconstriction and airway inflammation occur, leading to difficulty breathing. Choices A, B, and C are incorrect. Inflammation of the mucous membrane and bronchospasm (Choice A) are part of the pathophysiology of asthma but do not fully explain the symptoms during an acute episode. Increased mucus production and airway obstruction (Choice B) are also seen in asthma but are not the primary cause of acute symptoms. Hyperinflation of the lungs and alveolar collapse (Choice C) are not typical features of an acute asthma episode.

3. A nurse is caring for a client with Diabetes Insipidus. Which assessment finding warrants immediate intervention by the nurse?

• A. Hypernatremia
• B. Excessive thirst
• C. Elevated heart rate
• D. Poor skin turgor

Correct answer: A

Rationale: The correct answer is A: Hypernatremia. In a client with Diabetes Insipidus, hypernatremia, an elevated sodium level in the blood, can lead to neurological symptoms such as confusion, seizures, or coma. Immediate intervention is necessary to prevent these serious complications. Excessive thirst (choice B) is a common symptom of Diabetes Insipidus but does not require immediate intervention. Elevated heart rate (choice C) and poor skin turgor (choice D) are important assessments but are not as critical as hypernatremia in this context.

4. A client is receiving a full-strength continuous enteral tube feeding at 50 ml/hour and has developed diarrhea. The client has a new prescription to change the feeding to half strength. What intervention should the nurse implement?

• A. Add equal amounts of water and feeding to a feeding bag and infuse at 50 ml/hour
• B. Continue the full-strength feeding after decreasing the rate of infusion to 25 ml/hour
• C. Maintain the present feeding until diarrhea subsides and then begin the new prescription
• D. Withhold any further feeding until clarifying the prescription with the healthcare provider

Correct answer: A

Rationale: The correct intervention is to dilute the formula by adding equal amounts of water and feeding to a feeding bag and infusing it at 50 ml/hour. This can help alleviate the diarrhea that has developed. Diarrhea can occur as a complication of enteral tube feeding and can be due to a variety of causes, including hyperosmolar formula. Choice B is incorrect as continuing the full-strength feeding, even at a lower rate, may not address the issue of diarrhea. Choice C is incorrect because it is important to follow the new prescription to manage the diarrhea effectively. Choice D is incorrect as withholding feeding without taking appropriate action may delay necessary intervention.

5. A client with hyperthyroidism who has not been responsive to medications is admitted for evaluation. What action should the nurse implement?

• A. Notify the healthcare provider.
• B. Review the client's medication history.
• C. Prepare the client for thyroid function tests.
• D. Initiate seizure precautions.

Correct answer: A

Rationale: In a scenario where a client with hyperthyroidism is not responding to medications, the nurse's priority action should be to notify the healthcare provider. This is important because the client may require immediate intervention, such as adjusting the treatment plan or exploring alternative therapies. Reviewing the client's medication history (choice B) may be relevant but not as urgent as involving the healthcare provider. While preparing the client for thyroid function tests (choice C) may be necessary as part of the evaluation process, it is not the most immediate action to take. Initiating seizure precautions (choice D) is not directly related to the non-responsiveness of medications in hyperthyroidism and is not a priority in this situation.

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