Nursing Elites

1. A client is experiencing chest pain. Which statement made by the client indicates angina rather than a myocardial infarction?

• A. "I became dizzy when I stood up."?
• B. "I was nauseated and began vomiting."?
• C. "The pain started in my chest and stopped after I sat down."?
• D. "The pain began with a migraine and progressed to numbness in my left arm."?

Correct answer: B

Rationale: The correct answer is: '"The pain started in my chest and stopped after I sat down."? This statement suggests angina rather than a myocardial infarction because angina is typically triggered by exertion or stress and relieved by rest. Nausea and vomiting (Choice B) are more commonly associated with a myocardial infarction. Choices A and D are not typical symptoms of either angina or myocardial infarction.

2. Which of the following blood pressure parameters indicates PIH? Elevation over a baseline of:

• A. 30 mmHg systolic and/or 15 mmHg diastolic.
• B. 40 mmHg systolic and/or 20 mmHg diastolic.
• C. 10 mmHg systolic and/or 5 mmHg diastolic.
• D. 20 mmHg systolic and/or 20 mmHg diastolic.

Correct answer: A

Rationale: The correct answer is A: 30 mmHg systolic and/or 15 mmHg diastolic. These parameters indicate mild PIH (pregnancy-induced hypertension). Mild preeclampsia is characterized by an increase in systolic blood pressure greater than 30 mmHg or an increase in diastolic blood pressure greater than 15 mmHg, observed on two readings taken 6 hours apart (or reaching 140/90). Choice B (40 mmHg systolic and/or 20 mmHg diastolic) represents a more significant elevation and would indicate a more severe condition than mild PIH. Choices C (10 mmHg systolic and/or 5 mmHg diastolic) and D (20 mmHg systolic and/or 20 mmHg diastolic) do not meet the criteria for indicating PIH as they are below the accepted parameters for mild PIH.

3. After applying oxygen using bi-nasal prongs to a client who is having chest pain, the nurse should implement which intervention?

• A. Have the client take slow deep breaths in through their mouth and out through their nose.
• B. Post signs indicating that oxygen is in use on the client's door and in their room
• C. Apply Vaseline petroleum to both nares and 2 by 2 gauze around the oxygen tubing at the client's ears
• D. Encourage the client to hyperextend the neck, take a few deep breaths and cough.

Correct answer: A

Rationale: After applying oxygen using bi-nasal prongs to a client with chest pain, it is essential for the nurse to post signs indicating that oxygen is in use on the client's door and in their room. This safety precaution alerts healthcare providers and visitors that the client is receiving oxygen therapy, reducing the risk of accidents or misunderstandings. Choice A is incorrect because instructing the client to take slow deep breaths is not the appropriate intervention after applying oxygen. Choice C suggests applying Vaseline and gauze, which is unnecessary and not a standard practice. Choice D advising the client to hyperextend the neck, take deep breaths, and cough is not indicated after applying oxygen therapy and could potentially be harmful.

4. A client with stress incontinence should be advised:

• A. to avoid relying solely on absorbent undergarments.
• B. that Kegel exercises might help.
• C. that effective surgical treatments are available.
• D. that behavioral therapy can be beneficial.

Correct answer: B

Rationale: Kegel exercises, which involve tightening and releasing the pelvic floor muscles, can be beneficial for stress incontinence by strengthening the muscles that control urination. Choice A is incorrect as it is important for the client to know that absorbent undergarments can be used as a temporary solution but do not address the underlying issue. Choice C is incorrect as while surgical treatments are available, they are usually considered when conservative treatments like exercises and behavioral therapy have not been successful. Choice D is incorrect as behavioral therapy can be beneficial in managing stress incontinence through lifestyle and dietary modifications, bladder training, and more, contrary to the statement that it is ineffective.

5. While assessing a patient who has undergone a recent CABG, the nurse notices a mole with irregular edges and a bluish color. What should the nurse do next?

• A. Recommend a dermatological consult to the physician.
• B. Note the location of the mole and contact the physician via telephone.
• C. Note the location of the mole and follow-up with the attending physician through the medical record and a phone call.
• D. Remove the mole with a sharp debridement technique, following approval from the charge nurse.

Correct answer: C

Rationale: In this scenario, the nurse should note the location of the mole and follow up with the attending physician through the medical record and a phone call. This action is appropriate because a mole with irregular edges and a bluish color raises concern for melanoma, a type of skin cancer. Recommending a dermatological consult (Choice A) might delay the evaluation and management of the mole. Contacting the physician via telephone (Choice B) may not provide a documented record of the observation. Removing the mole without proper evaluation (Choice D) could be dangerous and is not within the nurse's scope of practice.

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