Nursing Elites

1. An adult male is brought to the ER after a motorcycle accident with periorbital bruising and bloody drainage from both ears. Which finding requires immediate attention?

• A. Rebound abdominal tenderness.
• B. Diminished breath sounds bilaterally.
• C. Rib pain with deep inspiration.
• D. Projectile vomiting.

Correct answer: D

Rationale: In this scenario, the patient's periorbital bruising and bloody drainage from both ears suggest a severe head injury. Projectile vomiting is a red flag symptom that may indicate increased intracranial pressure, which requires immediate attention to prevent further neurological deterioration. Rebound abdominal tenderness (choice A) typically indicates peritonitis and is not directly related to the primary head injury. Diminished breath sounds bilaterally (choice B) suggest a pneumothorax or hemothorax, which are important but not as immediately life-threatening in this context. Rib pain with deep inspiration (choice C) is concerning for rib fractures or pulmonary contusion, which are also important but do not take precedence over addressing the potential increased intracranial pressure.

2. A 78-year-old client with diabetes is being taught how to care for his feet. Which statement by the client indicates a need for further education?

• A. I will soak my feet in warm water every day.
• B. I will use a mirror to check my feet every day.
• C. I will apply lotion to my feet every day, avoiding the area between the toes.
• D. I will wear properly fitting shoes at all times.

Correct answer: A

Rationale: The correct answer is A. Soaking feet daily can lead to excessive moisture, which can increase the risk of skin breakdown or infection in diabetic clients. Choices B, C, and D are all correct statements for foot care in diabetic clients. Using a mirror for daily foot checks helps in early detection of any issues, applying lotion while avoiding the area between the toes helps keep the skin moisturized without creating a risk for fungal infections, and wearing properly fitting shoes is important to prevent pressure points and potential injuries.

3. The healthcare provider prescribes an IV infusion of isoproterenol in D5W at 300 mcg/hour. How many ml/hour should the nurse set the pump to?

• A. 100 ml/hour
• B. 75 ml/hour
• C. 60 ml/hour
• D. 125 ml/hour

Correct answer: B

Rationale: To calculate the correct infusion rate, convert 300 mcg/hour to mg/hour (300 mcg = 0.3 mg). Since the IV solution is 1 mg in 250 ml, the rate is calculated as 0.3 mg/hour = 75 ml/hour. Therefore, the nurse should set the pump to 75 ml/hour. Choice A (100 ml/hour) is incorrect as it does not reflect the accurate calculation. Choice C (60 ml/hour) is incorrect as it is lower than the correct rate. Choice D (125 ml/hour) is incorrect as it is higher than the correct rate.

4. A client is admitted with a large pleural effusion. Which procedure should the nurse prepare the client for?

• A. Thoracentesis.
• B. Endotracheal intubation.
• C. Chest tube insertion.
• D. Bronchoscopy.

Correct answer: A

Rationale: Corrected Rationale: The correct procedure for a client with a large pleural effusion is thoracentesis. Thoracentesis is a diagnostic and therapeutic procedure used to remove fluid from the pleural space, which can help relieve symptoms associated with pleural effusion. Choice B (Endotracheal intubation) is incorrect as it is a procedure to secure the airway by placing a tube into the trachea. Choice C (Chest tube insertion) is incorrect as it is typically done to drain air or fluid from the pleural space over a longer period. Choice D (Bronchoscopy) is incorrect as it is a procedure used to visualize the airways and diagnose lung conditions, not specifically for pleural effusion removal.

5. Which meal option should the nurse recommend for a client with renal disease who is following a low-protein diet?

• A. Grilled chicken with steamed vegetables
• B. Tofu stir-fry with rice
• C. Pasta with marinara sauce
• D. Baked salmon with quinoa

Correct answer: C

Rationale: The correct answer is C: Pasta with marinara sauce. Clients with renal disease following a low-protein diet should opt for lower-protein options. Pasta with marinara sauce is a suitable choice as it is lower in protein compared to grilled chicken, tofu, or salmon. Grilled chicken, tofu, and salmon are higher in protein content and are not ideal for individuals following a low-protein diet for renal disease as they may strain the kidneys.

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