Nursing Elites

1. A male client leaves his job at a nearby restaurant and visits the health clinic where he is diagnosed with viral conjunctivitis. While receiving discharge instructions from the nurse, the client states that he is feeling much better and plans to return to work for the afternoon shift. How should the nurse respond?

• A. advise the client to wear a face mask around other people
• B. ask the client what type of work he does at the restaurant
• C. instruct the client to use dark glasses if lighting is bright
• D. explain that the client should stay home for the next few days

Correct answer: D

Rationale: The correct answer is D: explain that the client should stay home for the next few days. Viral conjunctivitis is highly contagious, and the client should avoid close contact with others until it resolves. Returning to work while still contagious can lead to the spread of the infection to coworkers and customers. Choice A is incorrect because wearing a face mask may not provide sufficient protection against spreading the virus in a close work environment. Choice B is irrelevant to the situation as the focus should be on the client's health and preventing the spread of the infection. Choice C is also unrelated to the management of viral conjunctivitis and does not address the contagious nature of the condition.

2. The healthcare provider is caring for a client with hyperparathyroidism. Which laboratory result requires immediate intervention?

• A. Serum calcium of 11 mg/dL.
• B. Serum phosphorus of 3 mg/dL.
• C. Serum magnesium of 1.8 mg/dL.
• D. Serum albumin of 4 g/dL.

Correct answer: A

Rationale: A serum calcium level of 11 mg/dL indicates hypercalcemia, which can be a complication of hyperparathyroidism and requires immediate intervention. Hypercalcemia can lead to serious complications such as cardiac dysrhythmias, renal failure, and neurologic symptoms. Monitoring and managing serum calcium levels are crucial in clients with hyperparathyroidism. Serum phosphorus, magnesium, and albumin levels are important to assess in clients with hyperparathyroidism, but they do not require immediate intervention as hypercalcemia poses a more urgent risk.

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. Several employees who have a 10-year or longer smoking history ask for assistance with smoking cessation. A nurse develops a 2-month program that includes weekly group sessions on lifestyle changes and use of over-the-counter nicotine substitute products. Which measurement provides the best indication of the program's effectiveness?

• A. survey employees to determine how many are smoking 2 months after the end of the program
• B. test the employees' knowledge of OTC nicotine substitute products at the end of the program
• C. ask employees to inform the group if they stop smoking and if they start smoking again
• D. design a questionnaire that identifies lifestyle changes contributing to smoking cessation

Correct answer: A

Rationale: Surveying employees to determine how many are smoking 2 months after the end of the program provides a direct assessment of the program's effectiveness. This measurement evaluates the actual behavior change related to smoking cessation. Choice B, testing knowledge of OTC nicotine substitute products, does not directly measure smoking cessation outcomes. Choice C relies on self-reporting, which may not be accurate or reliable. Choice D focuses on identifying lifestyle changes but does not directly assess the program's impact on smoking cessation.

5. Following an emergency Cesarean delivery, the nurse encourages the new mother to breastfeed her newborn. The client asks why she should breastfeed now. Which information should the nurse provide?

• A. To bond with the baby.
• B. To help the baby latch on better.
• C. To stimulate contraction of the uterus.
• D. To promote milk production.

Correct answer: C

Rationale: The correct answer is C: 'To stimulate contraction of the uterus.' After delivery, breastfeeding helps in stimulating the release of oxytocin, which triggers the contraction of the uterus. This contraction is crucial to prevent uterine hemorrhage and facilitate the involution process. Choices A, B, and D are incorrect. While breastfeeding can indeed help in bonding with the baby and promoting milk production, in the immediate postpartum period after a Cesarean section, the priority is to ensure uterine contraction to prevent complications.

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