Nursing Elites

1. Which information about mammograms is most important to provide a post-menopausal female client?

• A. Breast self-examinations are not necessary if annual mammograms are obtained.
• B. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron.
• C. Yearly mammograms should be done regardless of previous normal screenings.
• D. Women at high risk should have annual routine and ultrasound mammograms.

Correct answer: C

Rationale: The most important information to provide a post-menopausal female client regarding mammograms is that yearly mammograms should be done regardless of previous normal screenings. It is crucial for post-menopausal women to continue regular mammograms as they are at a higher risk for breast cancer. Option A is incorrect as breast self-examinations are still recommended in addition to mammograms. Option B is not the most important information compared to the importance of regular mammograms. Option D is not the most important advice for all post-menopausal females but specifically for those at high risk, indicating a more targeted approach.

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 nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a “shift to the left” in the client’s white blood cell count. Which action should the nurse take?

• A. Request that the laboratory perform a differential analysis on the white blood cells.
• B. Notify the provider and start an intravenous line for parenteral antibiotics.
• C. Collaborate with the unlicensed assistive personnel (UAP) to strain the client’s urine for renal calculi.
• D. Assess the client for a potential allergic reaction and anaphylactic shock.

Correct answer: B

Rationale: A “shift to the left” in a white blood cell count indicates an increase in band cells, which is typically associated with urosepsis. In this scenario, the nurse should notify the provider and initiate IV antibiotics as a left shift is often seen in severe infections like urosepsis. Requesting a differential analysis on white blood cells would not be the immediate action needed in response to a left shift. Collaborating to strain urine for renal calculi is unrelated to the situation of a left shift in white blood cells due to urosepsis. Assessing for allergic reactions and anaphylactic shock is not the priority as a left shift is not indicative of an allergic response; it is associated with an increase in band cells, not eosinophils.

4. The client is being taught about the best time to plan sexual intercourse in order to conceive. Which information should be provided?

• A. Two weeks before menstruation.
• B. Vaginal mucous discharge is thick.
• C. Low basal temperature.
• D. First thing in the morning.

Correct answer: A

Rationale: The correct answer is A: 'Two weeks before menstruation.' Ovulation typically occurs 14 days before menstruation begins during a typical 28-day cycle. To increase the chances of conception, sexual intercourse should occur within 24 hours of ovulation. High estrogen levels during ovulation lead to changes in vaginal mucous discharge, making it more 'slippery' and stretchy. Basal temperature rises during ovulation. The timing of intercourse during the day is less significant than ensuring it happens around ovulation. The other options are incorrect because planning intercourse two weeks before menstruation is likely to miss the fertile window, thick vaginal mucous discharge indicates ovulation is approaching, and low basal temperature is not indicative of the fertile period.

5. The client with chronic kidney disease (CKD) is being taught about the necessary sodium restriction in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

• A. I am thrilled that I can continue to eat fast food.
• B. I will cut out bacon with my eggs every morning.
• C. My cooking style will change by not adding salt.
• D. I will probably lose weight by cutting out potato chips.

Correct answer: A

Rationale: Choice A, 'I am thrilled that I can continue to eat fast food,' indicates a lack of understanding as fast food is typically high in sodium, which is detrimental for individuals with CKD. The client should be advised to avoid fast food due to its high sodium content. Choices B, C, and D demonstrate a good understanding of the need for sodium restriction in the diet to prevent complications associated with CKD. Cutting out bacon, avoiding salt in cooking, and eliminating high-sodium snacks like potato chips are all positive steps towards managing CKD.

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