Nursing Elites

1. A client with a history of peptic ulcer disease is admitted with severe abdominal pain. Which assessment finding requires immediate intervention?

• A. Epigastric tenderness.
• B. Bowel sounds are hypoactive.
• C. The client reports sudden, severe abdominal pain.
• D. Bowel sounds are hyperactive.

Correct answer: C

Rationale: The correct answer is C. Sudden, severe abdominal pain can indicate a perforated ulcer, which is a medical emergency requiring immediate intervention. Epigastric tenderness (choice A) may be expected in a client with peptic ulcer disease but does not necessarily require immediate intervention. Hypoactive bowel sounds (choice B) are concerning but not as urgent as sudden, severe abdominal pain. Hyperactive bowel sounds (choice D) are more indicative of conditions like gastroenteritis rather than a perforated ulcer, making it a less critical finding compared to sudden, severe abdominal pain.

2. The healthcare provider is preparing to administer an intravenous antibiotic to a client with a central venous catheter. Which action is most important?

• A. Flush the catheter with heparin.
• B. Change the dressing at the insertion site.
• C. Check for blood return before administering the antibiotic.
• D. Use sterile technique when accessing the catheter.

Correct answer: D

Rationale: Using sterile technique when accessing the catheter is crucial to prevent infection in clients with a central venous catheter. This action helps maintain asepsis and reduces the risk of introducing pathogens into the catheter system. Flushing the catheter with heparin helps prevent occlusion but is not as crucial as ensuring sterile technique. Changing the dressing at the insertion site is important for assessing the site's condition but does not directly impact the administration of the antibiotic. Checking for blood return is essential to ensure proper catheter function, but sterile technique takes precedence to prevent infections.

3. The healthcare provider is caring for a client with a chest tube. Which observation indicates that the chest tube is functioning effectively?

• A. Continuous bubbling in the water-seal chamber.
• B. Intermittent bubbling in the suction control chamber.
• C. No fluctuation (tidaling) in the water-seal chamber.
• D. Drainage of clear, pale yellow fluid from the chest tube.

Correct answer: B

Rationale: Intermittent bubbling in the suction control chamber is the correct observation indicating effective functioning of the chest tube. This bubbling signifies that the suction system is working correctly and maintaining the desired negative pressure in the pleural space. Continuous bubbling in the water-seal chamber suggests an air leak, which is not a normal finding. No fluctuation (tidaling) in the water-seal chamber may indicate a blockage or lack of communication between the pleural space and the water-seal, which is not ideal. Drainage of clear, pale yellow fluid from the chest tube is a normal finding, but it does not specifically indicate the effectiveness of the chest tube function.

4. The healthcare provider is assessing a client who has a nasogastric tube to low intermittent suction. Which finding indicates that the client may have developed hypokalemia?

• A. Muscle weakness and cramps.
• B. Nausea and vomiting.
• C. Constipation.
• D. Increased blood pressure.

Correct answer: A

Rationale: Muscle weakness and cramps are characteristic signs of hypokalemia, a condition marked by low levels of potassium in the blood. Potassium is essential for proper muscle function, and its deficiency can lead to muscle weakness and cramps. In the context of a client with a nasogastric tube to low intermittent suction, the loss of potassium through suctioning can contribute to the development of hypokalemia. Nausea and vomiting (choice B) are more commonly associated with gastrointestinal issues rather than hypokalemia. Constipation (choice C) is not a typical finding of hypokalemia; instead, it can be a sign of other gastrointestinal problems. Increased blood pressure (choice D) is not a direct manifestation of hypokalemia; in fact, low potassium levels are more commonly associated with decreased blood pressure.

5. A public health nurse is implementing a program to improve vaccination rates among children in the community. Which intervention is most likely to be effective?

• A. Offering vaccinations at convenient locations and times
• B. Distributing educational materials about vaccines
• C. Providing incentives for getting vaccinated
• D. Hosting informational sessions for parents

Correct answer: A

Rationale: Offering vaccinations at convenient locations and times is the most effective intervention as it reduces barriers to access and makes it easier for parents to get their children vaccinated. This strategy directly addresses the issue of convenience and accessibility, which are common reasons for low vaccination rates. Distributing educational materials about vaccines (Choice B) can be helpful but may not directly address access issues. Providing incentives for getting vaccinated (Choice C) may be controversial and not sustainable in the long term. Hosting informational sessions for parents (Choice D) can be beneficial for education but may not directly improve vaccination rates as much as increasing access.

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