Nursing Elites

1. Four days following an abdominal aortic aneurysm repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?

• A. Elevate extremities on pillows
• B. Evaluate edema for pitting
• C. Assess pulses with a vascular Doppler
• D. Wrap the feet with warmed blankets

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to assess pulses with a vascular Doppler. The absence of palpable pedal pulses following an abdominal aortic aneurysm repair raises concerns about compromised blood flow, which could lead to serious complications like ischemia or thrombosis. Evaluating and confirming the presence or absence of pulses is crucial to guide further interventions. Elevating extremities on pillows (Choice A) may be beneficial for managing edema, but it is not the immediate priority when pulses are not palpable. Evaluating edema for pitting (Choice B) can provide additional information about fluid status but does not address the primary concern of absent pulses. Wrapping the feet with warmed blankets (Choice D) is not appropriate in this situation and may not address the underlying vascular issue.

2. What is the most common symptom of gastroesophageal reflux disease (GERD)?

• A. Heartburn.
• B. Nausea.
• C. Abdominal pain.
• D. Vomiting.

Correct answer: A

Rationale: The correct answer is A: Heartburn. Heartburn is the most common symptom of GERD as it occurs due to the reflux of stomach acid into the esophagus. This leads to a burning sensation in the chest that can worsen after eating, lying down, or bending over. Choice B, Nausea, is not typically the most common symptom of GERD, although it can occur in some cases. Choice C, Abdominal pain, is not a primary symptom of GERD and is more commonly associated with other gastrointestinal conditions. Choice D, Vomiting, is also not the most common symptom of GERD, although it can occur in severe cases or as a result of complications.

3. A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?

• A. Lymph node involvement is not significant.
• B. Small tumors are aggressive and indicate poor prognosis.
• C. The tumor's estrogen receptor guides treatment options.
• D. Stage I indicates metastasis.

Correct answer: C

Rationale: Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which is one of the most important prognostic factors in early-stage breast cancer.

4. A client with chronic kidney disease missed dialysis yesterday to attend a funeral. The client's wife calls the home health nurse and reports that her husband is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?

• A. Apply the client's home oxygen.
• B. Check for a thrill and bruit at the client's dialysis access site.
• C. Ensure the client avoids salt intake for the rest of the day.
• D. Take the client to the emergency department (ED).

Correct answer: D

Rationale: In this scenario, the most crucial instruction for the nurse to provide is to take the client to the emergency department (ED). Missing dialysis can lead to severe complications in clients with chronic kidney disease, such as electrolyte imbalances and fluid overload. Lethargy and difficulty in arousing the client suggest a critical situation that requires immediate medical attention. Applying home oxygen, checking the dialysis access site, and ensuring salt intake avoidance, although important, are not as urgent as seeking emergency care to address the potential severe complications from missed dialysis.

5. 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.

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