Nursing Elites

1. A nurse is caring for a client who has a pneumothorax and is being treated with a chest tube. Which of the following findings indicates that the lung has re-expanded?

• A. There is no fluctuation in the water seal chamber.
• B. There is continuous bubbling in the suction control chamber.
• C. There is tidaling in the water seal chamber.
• D. The drainage system is positioned at the level of the client's chest.

Correct answer: A

Rationale: The correct answer is A: 'There is no fluctuation in the water seal chamber.' In a client with a pneumothorax being treated with a chest tube, the absence of fluctuation in the water seal chamber indicates that the lung has re-expanded. This finding suggests that there is no air leak from the lung into the pleural space. Choices B and C are incorrect because continuous bubbling in the suction control chamber or tidaling in the water seal chamber would suggest ongoing air leakage, indicating that the lung has not fully re-expanded. Choice D is also incorrect as the position of the drainage system does not directly indicate lung re-expansion.

2. A nurse is providing discharge teaching to a client who had a stroke. What instruction should the nurse provide?

• A. Avoid lifting more than 5 pounds.
• B. Perform range-of-motion exercises daily.
• C. Take medications at the same time every day.
• D. Monitor blood pressure daily.

Correct answer: C

Rationale: The correct answer is C: 'Take medications at the same time every day.' Consistency in medication administration is crucial for stroke recovery to maintain therapeutic drug levels in the body. Choice A, 'Avoid lifting more than 5 pounds,' though important to prevent strain, is not directly related to medication adherence. Choice B, 'Perform range-of-motion exercises daily,' is beneficial for overall recovery but is not specific to medication management. Choice D, 'Monitor blood pressure daily,' is important but does not address the key aspect of medication regimen adherence.

3. A nurse is reviewing the laboratory report of a client who has been receiving lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the nurse expect?

• A. Withhold the next dose.
• B. Increase the dosage.
• C. Discontinue the medication.
• D. Administer the medication.

Correct answer: D

Rationale: Administering the medication is appropriate for a stable lithium level of 0.8 mEq/L. A level of 0.8 mEq/L falls within the therapeutic range for lithium, indicating that the client is receiving an adequate dose to maintain therapeutic effects. Withholding the next dose, increasing the dosage, or discontinuing the medication would not be indicated at this lithium level as it is within the desired range for therapeutic benefit. Therefore, the correct action would be to continue administering the medication to ensure the client maintains the therapeutic level of lithium.

4. A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. Which of the following instructions should the nurse include?

• A. Take this medication with orange juice to increase absorption.
• B. Take this medication on an empty stomach.
• C. Take this medication with milk if it causes stomach upset.
• D. Take this medication at bedtime.

Correct answer: A

Rationale: The correct instruction for a client prescribed ferrous sulfate is to take the medication with orange juice to enhance absorption. Orange juice is recommended because of its vitamin C content, which aids in the absorption of iron. Choice B, taking the medication on an empty stomach, is incorrect because ferrous sulfate is better absorbed with food. Choice C, taking the medication with milk if it causes stomach upset, is incorrect as calcium in milk can interfere with iron absorption. Choice D, taking the medication at bedtime, is incorrect as it is usually recommended to take iron supplements between meals or with food to enhance absorption.

5. A nurse is assessing a client who is postoperative following a thyroidectomy. The nurse should identify which of the following findings as an indication of hypocalcemia?

• A. Tingling in the fingers.
• B. Elevated blood pressure.
• C. Positive Chvostek's sign.
• D. Positive Kernig's sign.

Correct answer: A

Rationale: The correct answer is A: Tingling in the fingers. Tingling in the fingers is a common sign of hypocalcemia, often seen after a thyroidectomy. Hypocalcemia can occur post-thyroidectomy due to inadvertent damage or removal of the parathyroid glands which regulate calcium levels. Choices B, C, and D are incorrect. Elevated blood pressure is not typically associated with hypocalcemia. Positive Chvostek's sign is a clinical sign of hypocalcemia but is usually assessed as facial muscle twitching, not tingling in the fingers. Positive Kernig's sign is a test for meningitis, not related to hypocalcemia.

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