Nursing Elites

1. A client with an enlarged prostate is having trouble starting his flow of urine when using the bathroom. Another name for this condition is:

• A. Hesitancy
• B. Oliguria
• C. Retention
• D. Urgency

Correct answer: A

Rationale: Urinary hesitancy occurs when a client has difficulty starting a flow of urine while using the bathroom. Hesitancy may be due to physiological factors, such as obstruction from an enlarged prostate, or due to psychological factors, such as anxiety or embarrassment. Oliguria refers to decreased urine output, retention is the inability to empty the bladder fully, and urgency is the sudden and strong need to urinate.

2. When performing CPR, at what rate should chest compressions be applied?

• A. 100 per minute
• B. 60 per minute
• C. As quickly as possible
• D. 200 per minute

Correct answer: A

Rationale: During CPR, chest compressions should be applied at a rate of 100 compressions per minute in order to effectively circulate blood and oxygen to vital organs. Option A, '100 per minute,' is the correct answer as it aligns with the recommended compression rate in CPR guidelines. Option B, '60 per minute,' is incorrect as it is too slow and may not provide adequate circulation. Option C, 'As quickly as possible,' is vague and does not specify the recommended compression rate. Option D, '200 per minute,' is incorrect as it exceeds the recommended rate and may not be as effective in maintaining perfusion.

3. The functional health pattern assessment data states: 'Eats three meals a day and is of normal weight for height.' The nurse should draw which of the following conclusions about this data? Select all that apply.

• A. Client has an actual health problem
• B. Client has a wellness diagnosis
• C. Collaborative health problem needs to be written
• D. Possible nursing diagnosis exists

Correct answer: B

Rationale: The assessment data provided indicates a healthy pattern of nutrition and a normal weight for height, suggesting a positive health status. This aligns with a wellness diagnosis, such as 'Potential for enhanced nutrition,' which focuses on improving health further. An actual health problem refers to a current health issue present in the client, which is not evident in this data. Collaborative health problems involve interprofessional collaboration and are not indicated based on the information provided. While a diet assessment may be needed to evaluate food quality, the initial data suggests a wellness-focused approach to care.

4. When performing an EKG, the patient starts to laugh out of feelings of anxiety. What would you expect the EKG to show? (Choose the BEST answer.)

• A. Increased pulse rate, normal EKG
• B. Decreased pulse rate, abnormal EKG
• C. Tachycardia, poor EKG graph
• D. Bradycardia, poor EKG graph

Correct answer: C

Rationale: When a patient laughs due to anxiety during an EKG, it is likely to cause tachycardia, which is a rapid heart rate. This increased heart rate can lead to poor EKG graph quality as the electrical signals from large moving muscles can interfere with data collection from the chest leads. Therefore, in this scenario, the EKG is expected to show tachycardia with poor graph quality. Choices A, B, and D are incorrect because a patient laughing out of anxiety is more likely to result in an increased pulse rate (tachycardia) rather than a decreased pulse rate (bradycardia) or a normal EKG.

5. Patients who cannot move in their bed on their own should be turned at least ________________.

• A. once a day
• B. twice a day
• C. every 2 hours
• D. every 4 hours

Correct answer: C

Rationale: Patients who are unable to move in bed are at high risk of developing pressure ulcers and skin breakdown due to prolonged pressure on specific body areas. Turning these patients at least every 2 hours is crucial to relieve pressure, improve circulation, and prevent skin damage. More frequent turning may be necessary for patients with specific needs, such as those who are incontinent of urine and require additional care. Turning patients less frequently, such as once a day, twice a day, or every 4 hours, increases the risk of developing pressure ulcers and other complications. Therefore, the correct answer is to turn patients who cannot move in their bed on their own every 2 hours.

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