Nursing Elites

1. While caring for a client with a new tracheostomy, the nurse notices that the client is attempting to speak but is unable to. What should the nurse explain to the client regarding their inability to speak?

• A. Speaking is not possible because the tracheostomy tube blocks the vocal cords.
• B. The tracheostomy tube prevents air from reaching the vocal cords, making speech difficult.
• C. The client will regain the ability to speak once the tracheostomy tube is removed.
• D. The tracheostomy tube must be replaced with a speaking valve for the client to speak.

Correct answer: B

Rationale: The correct answer is B. The tracheostomy tube bypasses the vocal cords, preventing air from reaching them, which is necessary for speech. This makes speaking difficult but not impossible. Removing the tracheostomy tube does not automatically restore the ability to speak (choice C). While a speaking valve can be added later to allow speech, initially, the tracheostomy tube itself hinders air from reaching the vocal cords, making speech difficult (choice D is incorrect). Choice A is incorrect as the tracheostomy tube does not block the vocal cords directly; instead, it prevents air from reaching them.

2. While performing an inspection of a client's fingernails, the PN observes a suspected abnormality of the nail's shape and character. Which finding should the PN document?

• A. Clubbed nails
• B. Splinter hemorrhages
• C. Longitudinal ridges
• D. Koilonychia or spoon nails

Correct answer: A

Rationale: The correct answer is A: Clubbed nails. Clubbed nails are a significant finding often associated with chronic hypoxia or lung disease. The presence of clubbed nails should be documented for further evaluation. Splinter hemorrhages (Choice B) are tiny areas of bleeding under the nails and are associated with conditions like endocarditis. Longitudinal ridges (Choice C) are common and often a normal finding in older adults. Koilonychia or spoon nails (Choice D) refer to nails that are concave or scooped out, often seen in conditions like iron deficiency anemia or hemochromatosis. These conditions are not typically associated with chronic hypoxia or lung disease, making them less likely findings in this situation.

3. What should the nurse do to complete a focused assessment for a female client with inflamed and painful hemorrhoids?

• A. Determine if the client uses any over-the-counter preparations for hemorrhoids
• B. Place the client in a standing position, leaning over the exam bed for inspection
• C. Position the client in the left lateral position to inspect the perineal area for fissures or sacs
• D. Ask the client how long she has experienced discomfort related to hemorrhoids

Correct answer: D

Rationale: Asking the client about the duration of discomfort related to hemorrhoids is the best intervention to implement for a focused assessment. This information provides important context for assessing the severity and chronicity of the condition, which is crucial for developing an appropriate care plan. Choices A, B, and C do not directly address the need to gather information about the duration of symptoms, which is essential for understanding the client's condition.

4. What is the most common cause of hyperthyroidism?

• A. Graves' disease
• B. Hashimoto's thyroiditis
• C. Thyroid nodules
• D. Pituitary adenoma

Correct answer: A

Rationale: Corrected Rationale: Graves' disease is the most common cause of hyperthyroidism. It is characterized by an overactive thyroid gland due to autoantibodies stimulating the thyroid. Hashimoto's thyroiditis is actually a cause of hypothyroidism, not hyperthyroidism. Thyroid nodules and pituitary adenoma are not common causes of hyperthyroidism.

5. The nurse is performing a psychosocial assessment on an adolescent aged 14. Which emotional response is typical during early adolescence?

• A. Frequent anger
• B. Cooperativeness
• C. Moodiness
• D. Combativeness

Correct answer: C

Rationale: Moodiness is a typical emotional response during early adolescence. Hormonal changes and developmental challenges contribute to this behavior. While anger and combativeness can also be present during adolescence, they are not as consistently typical as moodiness. Cooperativeness, on the other hand, is a trait more commonly associated with later stages of development and maturity, rather than early adolescence.

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