Nursing Elites

1. A nurse in the telemetry unit is receiving the laboratory findings for an adult male client who is being treated for a myocardial infarction. Which of the following is an expected finding for the client?

• A. Troponin I (TnI) 8 ng/mL
• B. Brain natriuretic peptide (BNP) 10 ng/L
• C. Alanine aminotransferase (ALT) 45 units/L
• D. High-density lipoprotein (HDL) 75 mg/dL

Correct answer: A

Rationale: The correct answer is A. Troponin I is a specific marker for myocardial infarction, and levels of 8 ng/mL are elevated, indicating heart muscle damage. Brain natriuretic peptide (BNP) is more related to heart failure rather than myocardial infarction, making choice B incorrect. Alanine aminotransferase (ALT) is a liver enzyme and not specific to myocardial infarction, so choice C is incorrect. High-density lipoprotein (HDL) is a type of cholesterol and is not typically used to diagnose or monitor myocardial infarction, making choice D incorrect.

2. A nurse is admitting a client who has suspected appendicitis. Which of the following findings should the nurse report to the provider immediately?

• A. Distended, board-like abdomen
• B. WBC count of 15,000/mm³
• C. Rebound tenderness over McBurney’s point
• D. Temperature of 37.3°C (99.1°F)

Correct answer: A

Rationale: A distended, board-like abdomen is a concerning sign indicating the possibility of a ruptured appendix and peritonitis, which are medical emergencies. Reporting this finding immediately is crucial for prompt intervention. Choice B, an elevated WBC count, could indicate infection but is not as urgent as the risk of a ruptured appendix. Choice C, rebound tenderness over McBurney’s point, is a classic sign of appendicitis but does not indicate an immediate threat like a possible rupture. Choice D, a slightly elevated temperature, is a nonspecific finding and not as critical as the risk of peritonitis associated with a distended, board-like abdomen.

3. A healthcare provider is assessing a client with chronic obstructive pulmonary disease (COPD). Which of the following findings should the healthcare provider expect?

• A. Decreased respiratory rate
• B. Use of accessory muscles
• C. Improved lung sounds
• D. Increased energy levels

Correct answer: B

Rationale: The correct answer is B: 'Use of accessory muscles.' Clients with COPD often experience airway obstruction, leading to the use of accessory muscles to breathe. This compensatory mechanism helps them overcome the increased work of breathing. Choice A, 'Decreased respiratory rate,' is incorrect because clients with COPD typically have an increased respiratory rate due to the need for more effort to breathe. Choice C, 'Improved lung sounds,' is incorrect because COPD is characterized by wheezes, crackles, and diminished breath sounds. Choice D, 'Increased energy levels,' is incorrect because clients with COPD often experience fatigue due to the increased work of breathing and impaired gas exchange.

4. A nurse is caring for a client with deep vein thrombosis (DVT). Which action should the nurse take?

• A. Position the client with the affected extremity lower than the heart
• B. Administer acetaminophen for pain
• C. Massage the affected extremity every 4 hours
• D. Withhold heparin IV infusion

Correct answer: D

Rationale: Withholding heparin IV infusion is the priority if there is a risk of complications such as bleeding, which must be evaluated before continuing treatment.

5. A healthcare provider is caring for four clients. Which of the following tasks can the healthcare provider delegate to an assistive personnel?

• A. Perform chest compressions during cardiac resuscitation
• B. Perform a dressing change for a new amputee
• C. Assess the effectiveness of antiemetic medication
• D. Provide discharge instructions

Correct answer: A

Rationale: Performing chest compressions during cardiac resuscitation is a critical life-saving intervention that can be delegated to an assistive personnel during an emergency. This task requires immediate action and basic training, making it appropriate for delegation. Performing a dressing change for a new amputee involves specialized knowledge and skills, typically performed by licensed healthcare providers. Assessing the effectiveness of medication requires critical thinking and decision-making skills that are within the scope of a licensed healthcare provider. Providing discharge instructions involves educating the patient on post-discharge care and follow-up, which is typically done by a healthcare provider to ensure clear communication and understanding.

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