Nursing Elites

1. A client with heart failure is receiving furosemide. What assessment finding indicates the medication is effective?

• A. Increased urine output and weight loss.
• B. Increased heart rate and blood pressure.
• C. Decreased edema and improved peripheral pulses.
• D. Decreased shortness of breath and clear lung sounds.

Correct answer: C

Rationale: The correct answer is C: 'Decreased edema and improved peripheral pulses.' In a client with heart failure, furosemide is a diuretic that helps reduce fluid overload. Therefore, a decrease in edema (swelling due to fluid retention) and improved peripheral pulses (indicating better circulation) are signs that the medication is effective. Choices A, B, and D are incorrect. Increased urine output and weight loss (Choice A) may indicate the diuretic effect of furosemide but do not specifically reflect its effectiveness in heart failure. Increased heart rate and blood pressure (Choice B) are not desired effects of furosemide and may suggest adverse reactions. Decreased shortness of breath and clear lung sounds (Choice D) are related to improved respiratory status and may not directly reflect the effectiveness of furosemide in addressing fluid overload.

2. A client presents to the clinic with concerns about her left breast. Which assessment finding is most important for the nurse to report?

• A. Multiple firm, round, freely movable masses.
• B. A slight asymmetry of the breasts.
• C. A fixed nodular mass with dimpling of the skin.
• D. Bloody discharge from the nipple.

Correct answer: C

Rationale: The correct answer is C. A fixed nodular mass with dimpling of the skin is concerning for malignancy, such as breast cancer, and should be reported immediately for further evaluation. This finding is more suspicious compared to multiple firm, round, freely movable masses (choice A), which could be benign breast lumps. A slight asymmetry of the breasts (choice B) is a common finding and not as alarming as a fixed nodular mass with dimpling of the skin. Bloody discharge from the nipple (choice D) can be suggestive of other conditions like intraductal papilloma but is not as urgent as the finding described in choice C.

3. A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic episodes and a glycosylated hemoglobin (A1C) of 10%. Insulin glargine 10 units subcutaneously once a day at bedtime and a sliding scale of insulin aspart every 6 hours are prescribed. What actions should the nurse include in this client's plan of care?

• A. Teach subcutaneous injection technique, site rotation, and insulin management
• B. Coordinate carbohydrate-controlled meals at consistent times and intervals
• C. Review with the client proper foot care and prevention of injury
• D. All of the above

Correct answer: D

Rationale: Effective diabetes management involves comprehensive care, including proper foot care, insulin administration technique, and maintaining carbohydrate consistency with meals. All of these interventions are critical in reducing hyperglycemic episodes and managing diabetes.

4. The healthcare worker is wearing PPE while caring for a client. When exiting the room, which PPE should be removed first?

• A. Gloves
• B. Face shield
• C. Mask
• D. Gown

Correct answer: A

Rationale: Gloves should be removed first as they are most likely to be contaminated. This is followed by the gown, then face shield, and mask. Correct removal sequence helps prevent contamination. Removing gloves first reduces the risk of transferring pathogens from the gloves to other PPE or surfaces. Face shield and mask should be removed last as they protect mucous membranes from exposure to contaminants. Removing PPE in the correct sequence is crucial in preventing the spread of infections.

5. The nurse is preparing to administer a subcutaneous injection to a thin, elderly client. What is the most appropriate site for the injection?

• A. Dorsal aspect of the upper arm.
• B. Upper outer thigh.
• C. Lower abdomen.
• D. Lateral aspect of the upper arm.

Correct answer: B

Rationale: The correct answer is the upper outer thigh. In thin, elderly clients, the upper outer thigh is a recommended site for subcutaneous injections due to the presence of adequate subcutaneous tissue and muscle mass. The dorsal aspect of the upper arm may not provide enough subcutaneous tissue for proper absorption of the medication. The lower abdomen is not ideal for thin individuals as it may lead to injection into muscle rather than subcutaneous tissue. The lateral aspect of the upper arm is also not a commonly recommended site for subcutaneous injections.

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