Nursing Elites

1. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?

• A. Notify the healthcare provider
• B. Document that the pericarditis has resolved
• C. Ask the client to lean forward and listen again
• D. Prepare to insert a unilateral chest tube

Correct answer: C

Rationale: The correct action for the nurse to implement when unable to auscultate a pericardial friction rub in a client diagnosed with pericarditis is to ask the client to lean forward and listen again. Leaning forward can help bring the heart closer to the chest wall, making it easier to detect the rub. Option A (Notifying the healthcare provider) is incorrect because further assessment is needed before escalating the situation. Option B (Documenting that the pericarditis has resolved) is incorrect as the absence of a friction rub does not necessarily mean resolution. Option D (Preparing to insert a unilateral chest tube) is incorrect as this intervention is not indicated for the absence of a friction rub.

2. The nurse cares for a client receiving furosemide (Lasix). The nurse determines that teaching is effective if the client selects which of the following foods?

• A. One medium baked potato
• B. One slice of white bread
• C. One medium apple
• D. One scrambled egg

Correct answer: A

Rationale: The correct answer is A: One medium baked potato. Potatoes are high in potassium, which is crucial for clients on furosemide (Lasix) to prevent hypokalemia, as furosemide can cause potassium loss. White bread (choice B) and scrambled egg (choice D) are not high-potassium foods and do not address the specific need related to furosemide therapy. While apples (choice C) contain some potassium, they are not as rich in potassium as a baked potato, making them a less optimal choice for a client on furosemide.

3. Which risk factor would the nurse expect to find in the client diagnosed with pancreatic cancer?

• A. Chewing tobacco
• B. Low-fat diet
• C. Chronic alcoholism
• D. Exposure to industrial chemicals

Correct answer: C

Rationale: The correct answer is C: Chronic alcoholism. Chronic alcoholism is a significant risk factor for pancreatic cancer as alcohol has a damaging effect on the pancreas. Chewing tobacco (choice A) is associated with oral and throat cancers, not specifically pancreatic cancer. A low-fat diet (choice B) is generally considered a healthier choice and not a direct risk factor for pancreatic cancer. Exposure to industrial chemicals (choice D) may be linked to other types of cancers but is not a major risk factor for pancreatic cancer.

4. After attempting suicide by taking 200 acetaminophen (Tylenol) tablets, a client is transferred from the emergency department to the locked psychiatric unit. The client is now awake and alert but refuses to speak with the nurse. In this situation, what is the nurse’s first priority?

• A. Establish a rapport to foster trust
• B. Place the client in full restraints
• C. Try to communicate with the client in writing
• D. Ensure safety by initiating suicide precautions

Correct answer: D

Rationale: The nurse's first priority in this situation is to ensure the client's safety by initiating suicide precautions. This involves removing any potential means of self-harm and closely monitoring the client to prevent further attempts. While establishing rapport and communication are important, safety is paramount at this critical juncture. Placing the client in full restraints should be avoided unless absolutely necessary for immediate safety concerns.

5. Which of the following is the primary enlisted personnel performing nursing care duties at the various levels of health care?

• A. 68A30
• B. 68WM6
• C. Physician assistant
• D. 6.80E+21

Correct answer: B

Rationale: The correct answer is B: 68WM6. The 68WM6 (Practical Nurse) is the primary enlisted personnel performing nursing care duties. Choice A (68A30) does not correspond to a primary enlisted personnel role in nursing. Choice C (Physician assistant) is not an enlisted personnel role but rather a separate healthcare profession. Choice D (6.80E+21) is a numerical value and does not relate to enlisted personnel performing nursing care duties.

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