Nursing Elites

1. During a routine clinic visit, a nurse is assessing a 48-year-old client with a history of smoking. The client, who exercises regularly, reports calf pain during exercise that disappears at rest. Which of the following findings requires further evaluation?

• A. Heart rate of 57 bpm.
• B. SpO2 of 94% on room air.
• C. Blood pressure of 134/82.
• D. Ankle-brachial index of 0.65.

Correct answer: D

Rationale: An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client experiencing intermittent claudication, indicating compromised blood flow to the lower extremities during exercise. This finding requires further evaluation to assess the severity of arterial insufficiency and determine appropriate interventions. Choice A (Heart rate of 57 bpm) is within the normal range for an adult at rest and indicates good cardiovascular fitness. Choice B (SpO2 of 94% on room air) is slightly lower than the normal range but is generally acceptable in a healthy individual. Choice C (Blood pressure of 134/82) falls within the normal range and does not raise immediate concerns in this context.

2. A nurse checks the residual volume from a client’s nasogastric tube feeding before administering an intermittent tube feeding and finds 35 mL of gastric contents. What should the nurse do before administering the prescribed 100 mL of formula to the client?

• A. Pour the residual volume into the nasogastric tube through a syringe with the plunger removed
• B. Discard the residual volume properly and record it as output on the client’s fluid balance record
• C. Dilute the residual volume with water and inject it into the nasogastric tube, applying pressure on the plunger
• D. Mix the residual volume with the formula and pour it into the nasogastric tube, using a syringe without a plunger

Correct answer: A

Rationale: After checking the residual feeding contents, the nurse should pour the residual volume back into the stomach by removing the syringe bulb or plunger and then pouring the gastric contents, using the syringe, into the nasogastric tube. This helps ensure that the residual volume is reintroduced into the client's gastrointestinal tract. Option B is incorrect because discarding the residual volume without reinstilling it into the stomach can lead to inaccurate medication administration and potential electrolyte imbalances. Option C is incorrect as diluting the residual volume with water and injecting it under pressure can cause aspiration or discomfort for the client. Option D is incorrect because mixing the residual volume with the formula can alter the prescribed dosage and consistency, potentially affecting the client's nutritional intake and causing complications.

3. A patient’s serum osmolality is 305 mOsm/kg. Which term describes this patient’s body fluid osmolality?

• A. Iso-osmolar
• B. Hypo-osmolar
• C. Hyperosmolar
• D. Isotonic

Correct answer: C

Rationale: The correct term to describe a patient with a serum osmolality of 305 mOsm/kg is 'hyperosmolar.' Normal osmolality ranges from 280 to 300 mOsm/kg. A patient with an osmolality above this range is considered hyperosmolar. Choice A ('Iso-osmolar') implies an equal osmolality, which is not the case in this scenario. Choice B ('Hypo-osmolar') suggests a lower osmolality, which is incorrect based on the provided serum osmolality value. Choice D ('Isotonic') refers to a solution having the same osmolality as another solution, not describing the specific scenario of this patient being above the normal range.

4. An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should the nurse ask first?

• A. Are you drinking plenty of water?
• B. What medications are you taking?
• C. Have you tried laxatives or enemas?
• D. Has this type of thing ever happened before?

Correct answer: B

Rationale: In this scenario, the client's symptoms of dry mouth, constipation, and inability to void are indicative of anticholinergic side effects, which can be caused by medications like propantheline (Pro-Banthine) commonly used to treat incontinence. The first question the nurse should ask is about the client's medications to determine if they are taking anticholinergic drugs. This information is crucial as it can help differentiate between a simple side effect or a potential overdose. Asking about water intake (Choice A) may be relevant later but is not the priority in this situation. Questioning about laxatives or enemas (Choice C) and past occurrences (Choice D) are not as pertinent initially as identifying the client's current medication status.

5. The client who experiences angina has been advised to follow a low-cholesterol diet. Which of the following meals would be best?

• A. Hamburger, salad, and milkshake.
• B. Baked liver, green beans, and coffee.
• C. Spaghetti with tomato sauce, salad, and coffee.
• D. Fried chicken, green beans, and skim milk.

Correct answer: C

Rationale: The best meal option for a client with angina following a low-cholesterol diet is spaghetti with tomato sauce, salad, and coffee. This meal is lower in cholesterol content compared to the other options provided. Hamburger with salad and milkshake, baked liver with green beans and coffee, and fried chicken with green beans and skim milk are higher in cholesterol and may not be suitable for an individual with angina who needs to adhere to a low-cholesterol diet.

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