Nursing Elites

1. The client who has a history of Parkinson's disease for the past 5 years is being assessed by the nurse. What symptoms would this client most likely exhibit?

• A. Loss of short-term memory, facial tics, and grimaces, and constant writhing movements.
• B. Shuffling gait, masklike facial expression, and tremors of the head.
• C. Extreme muscular weakness, easy fatigability, and ptosis.
• D. Numbness of the extremities, loss of balance, and visual disturbances.

Correct answer: B

Rationale: Parkinson's Disease, a common neurologic progressive disorder in older clients, is characterized by symptoms such as shuffling gait, masklike facial expression, and tremors of the head and hands. Choice A is incorrect as symptoms like loss of short-term memory, facial tics, and constant writhing movements are not typically associated with Parkinson's disease. Choice C is incorrect as extreme muscular weakness, easy fatigability, and ptosis are more indicative of other conditions like myasthenia gravis. Choice D is incorrect as numbness of the extremities, loss of balance, and visual disturbances are not classic symptoms of Parkinson's disease.

2. A client has just undergone insertion of a chest tube that is attached to a closed chest drainage system. Which action should the nurse plan to take in the care of this client?

• A. Assessing the client’s chest for crepitus every 24 hours
• B. Taping the connections between the chest tube and the drainage system
• C. Adding 20 mL of sterile water to the suction control chamber every shift
• D. Recording the volume of secretions in the drainage collection chamber every 24 hours

Correct answer: B

Rationale: The correct action for the nurse to take in caring for a client with a chest tube connected to a closed chest drainage system is to tape the connections between the chest tube and the drainage system. This is done to prevent accidental disconnection, ensuring the system functions properly. Assessing the client’s chest for crepitus should be done more frequently than once every 24 hours to monitor for any air leaks. Adding sterile water to the suction control chamber is not necessary every shift; it should be done as needed to maintain the appropriate water level. Recording the volume of secretions in the drainage collection chamber should be done more frequently than every 24 hours, with hourly monitoring during the first 24 hours after insertion and every 8 hours thereafter to assess for changes or complications.

3. A client with a diagnosis of hypothermia is being admitted to the hospital by a nurse. Which of the following signs does the nurse anticipate that this client will exhibit?

• A. Increased heart rate and increased blood pressure
• B. Increased heart rate and decreased blood pressure
• C. Decreased heart rate and increased blood pressure
• D. Decreased heart rate and decreased blood pressure

Correct answer: D

Rationale: Hypothermia decreases the heart rate and blood pressure due to reduced metabolic needs of the body. With lower metabolic demands, the heart's workload decreases, leading to reductions in both heart rate and blood pressure. Choices A, B, and C are incorrect because hypothermia typically results in a decrease in heart rate and blood pressure, not an increase.

4. A client with chronic renal failure is prescribed a low-protein diet. The nurse should explain to the client that the purpose of this diet is to:

• A. Prevent fluid overload.
• B. Reduce the workload on the kidneys.
• C. Prevent dehydration.
• D. Maintain electrolyte balance.

Correct answer: B

Rationale: The correct answer is B: 'Reduce the workload on the kidneys.' A low-protein diet is prescribed for clients with chronic renal failure to decrease the production of urea and other nitrogenous wastes, which can accumulate in the body when the kidneys are not functioning properly. This reduction in protein intake helps to lessen the burden on the kidneys, as they may have difficulty in filtering and excreting waste products. Choice A is incorrect because fluid overload is more related to restrictions in fluid intake rather than protein intake. Choice C is incorrect as a low-protein diet does not directly prevent dehydration. Choice D is incorrect because while electrolyte balance is essential in renal failure, the primary purpose of a low-protein diet is to reduce the workload on the kidneys by limiting the production of waste products.

5. A nurse is assessing the status of a client with diabetes mellitus. The nurse concludes that the client is exhibiting adequate diabetic control if the serum level of glycosylated hemoglobin A1C (HbA1C) is less than:

• A. 7%
• B. 9%
• C. 10%
• D. 15%

Correct answer: A

Rationale: The correct answer is A: 7%. Glycosylated hemoglobin A1C (HbA1C) level of 7.0% or less is considered indicative of adequate diabetic control. This level reflects good long-term blood sugar management. Choices B, C, and D are incorrect because an HbA1C level above 7% indicates poor diabetic control and an increased risk of complications associated with diabetes, such as cardiovascular disease, neuropathy, and retinopathy.

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