Nursing Elites

1. A healthcare professional is preparing to palpate and percuss a patient's abdomen as part of the assessment process. Which of these findings would cause the healthcare professional to immediately discontinue this part of the assessment?

• A. The patient states, 'That sounds like it might hurt me.'
• B. There is a pulsating mass on the upper middle abdomen.
• C. The patient has black, tarry stools and anemia.
• D. The patient has had an endoscopic procedure two days prior.

Correct answer: B

Rationale: A pulsating mass on the upper middle abdomen is indicative of a life-threatening aortic aneurysm. Palpating or percussing such an area can potentially cause the aneurysm to rupture, leading to severe internal bleeding and endangering the patient's life. Therefore, the healthcare professional should immediately discontinue the assessment to prevent any harm.\nChoice A is incorrect because the patient expressing concerns about the procedure does not necessarily indicate a life-threatening condition. Choice C describes symptoms that should be further investigated but do not pose an immediate threat during abdominal assessment. Choice D, a prior endoscopic procedure, is not a contraindication for palpation or percussion of the abdomen unless there are specific complications or conditions related to the procedure that would require caution.

2. During an intake screening for a patient with hypertension who has been taking ramipril for 4 weeks, which statement made by the patient would be most important for the nurse to pass on to the physician?

• A. ''I get dizzy when I get out of bed.''
• B. ''I'm urinating much more than I used to.''
• C. ''I've been running on the treadmill for 10 minutes each day.''
• D. ''I can't get rid of this cough.''

Correct answer: D

Rationale: The correct answer is ''I can't get rid of this cough.'' Ramipril, an ACE inhibitor, commonly causes a persistent, dry cough as an adverse effect. This symptom can be indicative of bradykinin accumulation caused by ACE inhibitors. It is important for the nurse to inform the physician about this side effect so that a medication change to another class of antihypertensives, such as an ARB, may be considered. Choices A, B, and C are not directly related to the common adverse effects of ramipril and are not as concerning for a patient on this medication.

3. Mr. B is recovering from a surgical procedure that was performed four days ago. The nurse's assessment finds this client coughing up rust-colored sputum; his respiratory rate is 28/minute with expiratory grunting, and his lung sounds have coarse crackles on auscultation. Which of the following conditions is the most likely cause of these symptoms?

• A. Tuberculosis
• B. Pulmonary edema
• C. Pneumonia
• D. Histoplasmosis

Correct answer: C

Rationale: In this scenario, the client's presentation of coughing up rust-colored sputum, increased respiratory rate, expiratory grunting, and coarse crackles on lung auscultation suggests the development of pneumonia. Pneumonia is characterized by lung tissue inflammation or infection, often caused by various organisms. Symptoms may include productive cough, dyspnea, and abnormal breath sounds. Tuberculosis (Choice A) typically presents with a chronic cough, weight loss, and night sweats and is less likely in this acute post-operative setting. Pulmonary edema (Choice B) is characterized by pink, frothy sputum, crackles throughout the lungs, and typically occurs in the context of heart failure. Histoplasmosis (Choice D) is a fungal infection that usually presents with flu-like symptoms and is less likely to manifest with the specific respiratory findings described in this case.

4. An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time?

• A. Prone position
• B. On the stomach
• C. Left lateral position
• D. Right lateral position

Correct answer: C

Rationale: After surgical repair of a cleft lip on the right side, the nurse should position the infant carefully to ensure comfort and prevent complications. Placing the infant in the prone position or on the stomach is not recommended as it may cause rubbing of the surgical site against the mattress. The optimal position for the infant is the left lateral position, away from the surgical repair site, to minimize the risk of trauma. Placing the infant on the right lateral position would be contraindicated as it is on the side of the repair. Additionally, positioning the infant upright on the back can help prevent airway obstruction by secretions, blood, or the tongue. Therefore, the correct choice is to place the infant in the left lateral position to promote safety and comfort post cleft lip surgery.

5. When administering a shot of Vitamin K to a 30-day-old infant, which of the following target areas is the most appropriate?

• A. Gluteus maximus
• B. Gluteus minimus
• C. Vastus lateralis
• D. Vastus medialis

Correct answer: C

Rationale: When administering medications to infants, it is common to use the vastus lateralis muscle in the thigh for injections. The preferred site is the junction of the upper and middle thirds of the vastus lateralis muscle. This area provides a good muscle mass for the injection and minimizes the risk of hitting nerves or blood vessels. The gluteus maximus and gluteus minimus are not typically used for infant injections due to the risk of injury to the sciatic nerve. The vastus medialis is not as commonly used as the vastus lateralis for infant injections.

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