Nursing Elites

1. After a client undergoes a left lower lobe lung resection for lung cancer, which post-operative measure would typically be included in the plan?

• A. Closed chest drainage
• B. A tracheostomy
• C. A mediastinal tube
• D. Percussion vibration and drainage

Correct answer: A

Rationale: After a lung resection, such as the removal of the left lower lobe for lung cancer, closed chest drainage is a common post-operative measure to help drain any excess air or fluid from the chest cavity. A tracheostomy is not typically needed for this procedure, so choice B is incorrect. Similarly, a mediastinal tube is not routinely inserted following a left lower lobe lung resection, making choice C incorrect. Percussion vibration and drainage are not indicated for this type of surgery, so choice D is also incorrect. Therefore, the correct answer is closed chest drainage.

2. While the client is receiving quinidine, the nurse should monitor the ECG for:

• A. Peaked P wave
• B. Elevated ST segment
• C. Inverted T wave
• D. Prolonged QT interval

Correct answer: D

Rationale: Quinidine can cause widened Q-T intervals and heart block, leading to a prolonged QT interval on the ECG. Other signs of myocardial toxicity associated with quinidine include notched P waves and widened QRS complexes. Common side effects of quinidine include diarrhea, nausea, and vomiting, while less common effects may include tinnitus, vertigo, headache, visual disturbances, and confusion. Monitoring for a prolonged QT interval is crucial due to the potential risk of serious arrhythmias. Choices A, B, and C are not typically associated with the use of quinidine and are therefore incorrect in this context.

3. A 20-year-old female has a prescription for tetracycline. While teaching the client how to take her medicine, the nurse learns that the client is also taking Ortho-Novum oral contraceptive pills. Which instructions should be included in the teaching plan?

• A. The oral contraceptives will decrease the effectiveness of the tetracycline.
• B. Nausea often results from taking oral contraceptives and antibiotics.
• C. Toxicity can result when taking these two medications together.
• D. Antibiotics can decrease the effectiveness of oral contraceptives, so the client should use an alternate method of birth control.

Correct answer: D

Rationale: When antibiotics and oral contraceptives are taken together, the effectiveness of the oral contraceptives can be reduced, increasing the risk of pregnancy. Therefore, it is important to advise the client to use an alternate method of birth control to prevent unintended pregnancy. Choices A, B, and C are incorrect because there is no evidence to suggest that oral contraceptives decrease the effectiveness of tetracycline, cause nausea, or result in toxicity when taken with antibiotics.

4. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's:

• A. feelings about what has been described
• B. thoughts about what has been described
• C. possible solutions to the problem
• D. intent in sharing the description

Correct answer: B

Rationale: In a psychosocial assessment, the nurse should progress from having the client describe problematic behaviors to eliciting their thoughts about the dilemmas. This step provides essential assessment data and insights into the client's interpretation of the situation. Asking about feelings, solutions, or intent in sharing the description is premature at this stage. Understanding the client's thoughts is crucial before delving into more complex emotional or problem-solving aspects. Therefore, the correct answer is to elicit the client's thoughts about the described behaviors and situations, as this helps the nurse gain a deeper understanding of the client's perspective and thought processes.

5. A 50-milliliter (ml) bolus of normal saline fluid is ordered by the physician. The physician wants it to infuse in 30 minutes. The nurse should set the pump rate at:

• A. 100 ml per hour for one hour.
• B. 60 ml per hour for one-half hour
• C. 120 ml per hour for one hour.
• D. 50 ml per hour for one hour.

Correct answer: A

Rationale: To infuse a 50 ml bolus in 30 minutes, the rate should be calculated as follows: 50 ml / 30 min = 100 ml per hour. Therefore, the correct answer is to set the pump rate at 100 ml per hour for one hour. Choice A is the correct rate based on the calculation. Choices B, C, and D all provide incorrect rates that do not match the physician's order. Choice B would only deliver 30 ml in 30 minutes, not the ordered 50 ml. Choice C would deliver 120 ml in one hour, which is 20 ml more than ordered. Choice D would only provide 25 ml over 30 minutes, not the full 50 ml prescribed.

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