Nursing Elites

1. After a left heart catheterization (LHC), a client complains of severe foot pain on the side of the femoral stick. The nurse notes pulselessness, pallor, and a cold extremity. What should the nurse's next action be?

• A. Administer an anticoagulant.
• B. Warm the room and re-assess.
• C. Increase IV fluids.
• D. Notify the physician stat.

Correct answer: D

Rationale: The correct action for the nurse to take next is to notify the physician immediately (stat). The client's symptoms of foot pain, pulselessness, pallor, and cold extremity suggest a potential vascular complication, such as arterial occlusion. Prompt notification of the physician is crucial as this condition requires urgent intervention to restore blood flow and prevent tissue damage. Administering an anticoagulant (Choice A) without physician evaluation could be harmful as the underlying cause needs to be determined first. Warming the room and re-assessing (Choice B) may delay necessary treatment. Increasing IV fluids (Choice C) is unlikely to address the urgent vascular issue indicated by the symptoms described.

2. One week ago, a client was involved in a motor vehicle crash (MVC) and was brought to the Emergency Department (ED). In the emergency department, the client received two stitches to the forehead and was sent home. Today, the client's spouse notes that the client 'acts like he is drunk' and cannot control his right foot and arm. The nurse will suspect?

• A. Meningitis
• B. Absence seizure
• C. Subdural hematoma
• D. Meniere's disease

Correct answer: C

Rationale: Yes! The nurse will suspect a subdural hematoma. In this case, the client's presentation of acting intoxicated and experiencing loss of motor control in the right foot and arm is indicative of an acute subdural hematoma. This condition can occur after a head injury with a slow venous bleed, where symptoms may not show until compensation mechanisms are overwhelmed. Meningitis (choice A) usually presents with fever, headache, and neck stiffness. Absence seizure (choice B) is characterized by brief periods of unconsciousness without convulsions. Meniere's disease (choice D) manifests with symptoms like vertigo, hearing loss, and tinnitus, which do not match the client's current symptoms.

3. The schizophrenic client who is admitted to the hospital for possible bowel obstruction has an NG tube and complains of pain. What should the nurse do at this time?

• A. Decrease the stimuli and observe frequently
• B. Administer the PRN sedative
• C. Call the physician immediately
• D. Administer the PRN pain medication

Correct answer: D

Rationale: In this scenario, the nurse should administer the PRN (as needed) pain medication to address the schizophrenic client's complaint of pain. It is essential to provide relief and comfort to the client experiencing pain. Option A, decreasing stimuli and observing frequently, may not address the underlying cause of pain and delay relief. Option B, administering a sedative, does not target the pain but may mask symptoms. Option C, calling the physician immediately, while important in some situations, is not the most immediate action needed to alleviate the client's pain. Therefore, the most appropriate action at this time is to administer the PRN pain medication to help alleviate the client's discomfort.

4. A patient asks a nurse the following question: Exposure to TB can be best identified with which of the following procedures?

• A. Chest x-ray
• B. Mantoux test
• C. Breath sounds examination
• D. Sputum culture for Mycobacterium tuberculosis

Correct answer: B

Rationale: The Mantoux test, also known as the tuberculin skin test, is the most appropriate and accurate test to identify exposure to TB. This test involves injecting a small amount of PPD tuberculin under the top layer of the skin, and a positive reaction indicates exposure to the TB bacteria. Choice A, a chest x-ray, is useful for detecting active TB disease but not exposure. Choice C, a breath sounds examination, is not a specific test for TB exposure. Choice D, a sputum culture for Mycobacterium tuberculosis, is used to diagnose active TB infection rather than exposure.

5. What is the most common cause of acute renal failure?

• A. Shock
• B. Nephrotoxic drugs
• C. Enlarged prostate
• D. Diabetes

Correct answer: A

Rationale: The correct answer is 'Shock.' Acute renal failure is commonly caused by inadequate blood flow to the kidneys, which can occur in cases of shock. This leads to decreased kidney function and potential kidney damage. While nephrotoxic drugs can also cause acute renal failure, shock is the primary and most common cause. An enlarged prostate may lead to obstructive uropathy but is not the most prevalent cause of acute renal failure. Diabetes is typically associated with chronic kidney disease rather than acute renal failure.

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