Nursing Elites

1. When working with a large population of African-American clients at a community health center, which priority assessment should a nurse include?

• A. Measure height and weight.
• B. Assess blood pressure.
• C. Observe for any signs of abuse.
• D. Ask about medications.

Correct answer: B

Rationale: Assessing blood pressure is the priority assessment when working with a population of African-American clients due to the high prevalence of hypertension in this group. African Americans have a higher risk of hypertension, which can lead to complications like end-stage renal disease. Monitoring blood pressure allows for the early detection and management of hypertension. While measuring height and weight, observing for signs of abuse, and asking about medications are important assessments, assessing blood pressure is crucial in this context to address the specific health needs of African-American clients.

2. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client’s blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take?

• A. Position the client to lay on the surgical incision.
• B. Measure the specific gravity of the client’s urine.
• C. Administer intravenous pain medications.
• D. Assess the rate and quality of the client’s pulse.

Correct answer: D

Rationale: The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Re-positioning the client, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

3. A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the best for the nurse to provide?

• A. Check it again in one month, and if it is still there schedule an appointment.
• B. Most lumps are benign, but it is always best to come in for an examination.
• C. Try not to worry too much about it, because usually, most lumps are benign.
• D. If you are in your menstrual period it is not a good time to check for lumps.

Correct answer: B

Rationale: The nurse advising the client to come in provides the best response because it addresses the client's anxiety most effectively and encourages prompt and immediate action for a potential problem.

4. A healthcare professional assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?

• A. A 36-year-old female who has never been pregnant
• B. A 42-year-old male who is prescribed cyclophosphamide
• C. A 58-year-old female who is not taking estrogen replacement
• D. A 77-year-old male with mild congestive heart failure

Correct answer: C

Rationale: Females are at higher risk of developing bacterial cystitis due to their shorter urethra compared to males. Postmenopausal women not on estrogen replacement therapy are particularly susceptible to cystitis because of changes in vaginal and urethral cells. This increases the risk of bacterial infection. The other options do not have the same level of risk as the postmenopausal woman not using hormone replacement therapy. A never-pregnant middle-aged woman does not have the same increased risk as a postmenopausal woman with hormonal changes.

5. What is the primary nursing intervention for a patient experiencing an acute asthma attack?

• A. Administering bronchodilators.
• B. Administering antibiotics.
• C. Administering IV fluids.
• D. Administering corticosteroids.

Correct answer: A

Rationale: The correct answer is administering bronchodilators. During an acute asthma attack, the primary goal is to relieve airway constriction and bronchospasm to improve breathing. Bronchodilators, such as short-acting beta-agonists, are the cornerstone of treatment as they help dilate the airways quickly. Administering antibiotics (choice B) is not indicated unless there is an underlying bacterial infection. Administering IV fluids (choice C) may be necessary in some cases, but it is not the primary intervention for an acute asthma attack. Administering corticosteroids (choice D) is often used as an adjunct therapy to reduce airway inflammation, but it is not the primary intervention during the acute phase of an asthma attack.

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