Nursing Elites

1. A nurse is assessing the chest tube drainage system of a postoperative client who has undergone a right upper lobectomy. The closed drainage system contains 300 mL of bloody drainage, and the nurse notes intermittent bubbling in the water seal chamber. One hour after the initial assessment, the nurse notes that the bubbling in the water seal chamber is now constant, and the client appears dyspneic. On the basis of these findings, the nurse should first assess:

• A. The client’s vital signs
• B. The amount of drainage
• C. The client’s lung sounds
• D. The chest tube connections

Correct answer: D

Rationale: The client’s dyspnea is most likely related to an air leak caused by a loose connection in the chest tube system. Checking the chest tube connections should be the initial action because correcting an air leak can quickly resolve the client's symptoms. If a leak is found and corrected, the dyspnea should improve. Assessing the client’s vital signs (Option A) is important, but addressing the potential cause of dyspnea takes precedence. Monitoring the amount of drainage (Option B) is necessary for assessing the client's overall condition, but in this case, the dyspnea is likely due to an air leak. Checking the client’s lung sounds (Option C) is essential for respiratory assessment, but addressing the air leak should be the immediate priority to ensure adequate lung expansion and oxygenation.

2. Which client is at greatest risk for coronary artery disease?

• A. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
• B. A 43-year-old male with a family history of CAD and a cholesterol level of 158 (8.8 mmol/L).
• C. A 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin.
• D. A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L).

Correct answer: D

Rationale: The 65-year-old female who is obese with a high LDL level of 188 (10.4 mmol/L) is at the greatest risk for coronary artery disease. Obesity and high LDL cholesterol levels are significant risk factors for developing coronary artery disease. While factors like mitral valve prolapse (choice A) and a family history of CAD (choice B) can contribute to the risk, they are not as significant as obesity and high LDL levels. Choice C, a 56-year-old male with high HDL and taking atorvastatin, is actually at lower risk due to the high HDL levels and being on statin therapy, which helps reduce cholesterol levels and lower the risk of coronary artery disease.

3. A client who underwent surgery and experienced significant blood loss is being cared for by a nurse. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)

• A. Urine output of 100 mL in 4 hours
• B. Large amount of sediment in the urine
• C. A & B
• D. Amber, odorless urine

Correct answer: C

Rationale: The nurse must monitor for signs of acute kidney injury in a postoperative client who had major blood loss. Low urine output, presence of sediment in the urine, and low blood pressure should raise concerns and be reported to the healthcare provider promptly. Postoperatively, assessing urine characteristics is crucial. Sediment, hematuria, and urine output less than 0.5 mL/kg/hour for 3 to 4 hours should be reported. While a urine output of 100 mL in 4 hours is low, it should be compared to the recommended 0.5 mL/kg/hour over a longer period. Perfusion to the kidneys is a priority, hence the importance of addressing low blood pressure. Amber, odorless urine is considered normal and does not indicate an immediate concern for acute kidney injury, unlike low urine output and presence of sediment.

4. What is the most common cause of coronary artery disease?

• A. Atherosclerosis.
• B. Hyperlipidemia.
• C. Diabetes.
• D. Smoking.

Correct answer: A

Rationale: The correct answer is Atherosclerosis. It is the primary cause of coronary artery disease, as it involves the buildup of plaque in the arteries, restricting blood flow to the heart. Hyperlipidemia (choice B) contributes to atherosclerosis by increasing cholesterol levels in the blood but is not the direct cause of coronary artery disease. Diabetes (choice C) can accelerate atherosclerosis due to high blood sugar levels, but it is not the most common cause. Smoking (choice D) is a significant risk factor for developing coronary artery disease but is not the primary cause.

5. A healthcare professional reviews a client’s laboratory results. Which results from the client’s urinalysis should the healthcare professional identify as normal? (Select all that apply.)

• A. pH: 6
• B. Specific gravity: 1.015
• C. Glucose: negative
• D. All of the above

Correct answer: D

Rationale: In a urinalysis, a pH of 6 is within the normal range (typically between 4.6 and 8); a specific gravity of 1.015 is considered normal (usually ranging between 1.005 to 1.030); and a negative glucose result is also normal. Therefore, choices A, B, and C are correct as they fall within the normal values for a urinalysis. Choices A, B, and C are the correct answers, as the pH, specific gravity, and glucose levels are within the normal range for a urinalysis. Choice D is correct because all the listed values are normal. Choices A, B, and C are the correct options as they meet the criteria for normal urinalysis values. The other choices do not fall within the normal range for a urinalysis.

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