Nursing Elites

1. The nurse is caring for a client who is postoperative following a thyroidectomy. Which assessment finding is most concerning?

• A. Slight difficulty swallowing
• B. Hoarse voice
• C. Positive Chvostek's sign
• D. Pain at the incision site

Correct answer: C

Rationale: A positive Chvostek's sign is the most concerning assessment finding as it suggests hypocalcemia, which is a potential complication following thyroidectomy. Hypocalcemia can lead to serious complications such as tetany and laryngospasm. Immediate intervention is required to prevent further complications. Choices A, B, and D are common post-thyroidectomy findings and are expected during the immediate postoperative period. Slight difficulty swallowing may be due to postoperative swelling, a hoarse voice may be temporary due to intubation trauma, and pain at the incision site is normal after surgery.

2. A preschooler with constipation needs to increase fiber intake. Which snack suggestion should the nurse provide?

• A. Oatmeal cookies
• B. Cheese sticks
• C. Yogurt
• D. Apple slices

Correct answer: A

Rationale: Oatmeal cookies are the best snack suggestion for a preschooler with constipation needing to increase fiber intake. Oatmeal is high in fiber, which helps relieve constipation. Cheese sticks, yogurt, and apple slices are not as high in fiber content as oatmeal and may not be as effective in addressing the constipation issue in this scenario.

3. A client with hypertension is prescribed a calcium channel blocker. Which client statement indicates that further teaching is needed?

• A. ‘I will take my medication at the same time every day.’
• B. ‘I should avoid drinking grapefruit juice while on this medication.’
• C. ‘I should increase my intake of calcium-rich foods.’
• D. ‘I should reduce my fluid intake to control my blood pressure.’

Correct answer: D

Rationale: The correct answer is D. The statement ‘I should reduce my fluid intake to control my blood pressure’ indicates a misunderstanding. It is important to note that fluid restriction is not typically necessary when taking calcium channel blockers. Choices A, B, and C demonstrate good understanding of medication adherence, dietary precautions, and nutrition recommendations when taking a calcium channel blocker, making them incorrect choices for further teaching.

4. An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the charge nurse that a client has a weak pulse with a rate of 44 beats/minute. What action should the charge nurse implement?

• A. Instruct the UAP to count the client's apical pulse rate for sixty seconds.
• B. Determine if the UAP also measured the client's capillary refill time.
• C. Assign a practical nurse (LPN) to determine if an apical-radial pulse deficit is present.
• D. Notify the healthcare provider of the abnormal pulse rate and pulse volume.

Correct answer: C

Rationale: The correct action for the charge nurse to implement in this situation is to assign a practical nurse (LPN) to determine if an apical-radial pulse deficit is present. This helps to confirm the accuracy of the reported weak pulse. In this scenario, it is crucial to involve a licensed nurse to further assess the situation and provide a more comprehensive evaluation. Inaccurate pulse readings can lead to inappropriate interventions or unnecessary alarm. Instructing the UAP to count the apical pulse may not address the accuracy issue. Checking capillary refill time is not directly related to confirming the weak pulse rate. Notifying the healthcare provider immediately may be premature without confirming the accuracy of the pulse reading first.

5. A client with a history of coronary artery disease (CAD) is admitted with chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG). An electrocardiogram should be performed first to assess for cardiac ischemia in a client with a history of CAD and chest pain. An ECG provides immediate information about the heart's electrical activity, helping to identify signs of ischemia or a heart attack. While other diagnostic tests like chest X-ray, arterial blood gases, and echocardiogram may also be necessary in the evaluation of chest pain, they do not provide the initial direct assessment of cardiac ischemia that an ECG does.

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