Nursing Elites

1. A healthcare provider is caring for a client who has a heart murmur. The healthcare provider is preparing to auscultate the pulmonary valve. Over which of the following locations should the healthcare provider place the bell of the stethoscope?

• A. Second intercostal space at the left sternal border
• B. Fifth intercostal space at the midclavicular line
• C. Fourth intercostal space at the left sternal border
• D. Fifth intercostal space at the left anterior axillary line

Correct answer: A

Rationale: The correct location to auscultate the pulmonary valve is the second intercostal space at the left sternal border. This area is where the pulmonary valve can best be heard due to its anatomical position. Choice B, the fifth intercostal space at the midclavicular line, is the location for auscultating the mitral valve. Choice C, the fourth intercostal space at the left sternal border, is the area for the tricuspid valve. Choice D, the fifth intercostal space at the left anterior axillary line, is the site for listening to the mitral valve as well. Therefore, option A is the correct choice for auscultating the pulmonary valve.

2. A client scheduled for abdominal surgery reports being worried. Which of the following actions should the nurse take?

• A. Offer information on a relaxation technique and ask if the client is interested in trying it.
• B. Request a social worker to see the client to discuss meditation.
• C. Attempt to use biofeedback techniques with the client.
• D. Tell the client many people feel the same way before surgery and to think of something else.

Correct answer: A

Rationale: Offering relaxation techniques addresses the client's immediate concern by providing a proactive approach to managing anxiety. It shows empathy and offers a practical solution. Requesting a social worker for meditation (Choice B) may not be the most direct response to the client's immediate worry. Attempting biofeedback (Choice C) may not be suitable without the client's interest or consent. Telling the client to think of something else (Choice D) dismisses the client's feelings and does not provide constructive support.

3. A nurse overhears a colleague informing a client that he will administer her medication by injection if she refuses to swallow her pills. The nurse should recognize that the colleague is committing which of the following torts?

• A. Defamation - harming someone's reputation through false statements.
• B. Malpractice - professional negligence or misconduct.
• C. Assault - threatening to cause harm to someone.
• D. Battery - intentional harmful or offensive physical contact.

Correct answer: C

Rationale: In this scenario, the colleague's action of informing the client that he will administer medication by injection if she refuses to swallow her pills constitutes assault. Assault is the act of threatening harm that causes fear of imminent harm. It does not involve physical contact but rather the apprehension of an imminent harmful or offensive act. Defamation, choice A, is incorrect as it involves harming someone's reputation through false statements. Malpractice, choice B, is also incorrect as it refers to professional negligence or misconduct in performing duties. Battery, choice D, is not the correct answer as it involves intentional harmful or offensive physical contact with the person.

4. A client is reporting difficulty falling asleep. Which of the following measures should the nurse recommend?

• A. Drink a cup of hot cocoa before bedtime
• B. Exercise 1 hour before going to bed
• C. Use progressive relaxation techniques at bedtime
• D. Reflect on the day's activities before going to bed

Correct answer: C

Rationale: The correct answer is to recommend the client to use progressive relaxation techniques at bedtime. Progressive relaxation techniques help reduce stress and muscle tension, which can promote better sleep. Choice A, drinking a cup of hot cocoa before bedtime, contains caffeine which can interfere with falling asleep. Choice B, exercising 1 hour before going to bed, can stimulate the body and mind, making it harder to fall asleep. Choice D, reflecting on the day's activities before going to bed, may lead to increased mental activity and prevent relaxation, making it difficult to fall asleep.

5. The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN) via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the TPN solution has run out and the next TPN solution is not available. What immediate action should the nurse take?

• A. Infuse normal saline at a keep-vein-open rate.
• B. Discontinue the IV and flush the port with heparin.
• C. Infuse 10% dextrose and water at 54 ml/hr.
• D. Obtain a stat blood glucose level and notify the healthcare provider.

Correct answer: C

Rationale: Infusing 10% dextrose and water at 54 ml/hr is the correct action to prevent hypoglycemia until the next TPN solution becomes available. This solution will help maintain the client's glucose levels. Infusing normal saline at a keep-vein-open rate (Choice A) is not appropriate for maintaining glucose levels and would not address the nutritional needs provided by TPN. Discontinuing the IV and flushing the port with heparin (Choice B) is unnecessary and not indicated in this situation as the client still needs fluid and nutrition. Obtaining a stat blood glucose level and notifying the healthcare provider (Choice D) can be done later but is not the immediate action required when the TPN solution has run out.

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