Nursing Elites

1. Which signs/symptoms would the nurse expect to find in the client diagnosed with an insulinoma?

• A. Nervousness, jitteriness, and diaphoresis
• B. Flushed skin, dry mouth, and tented skin turgor
• C. Polyuria, polydipsia, polyphagia
• D. Hypertension, tachycardia, and feeling hot

Correct answer: A

Rationale: Corrected Rationale: Insulinomas lead to excessive insulin production, causing hypoglycemia. Symptoms of hypoglycemia include nervousness, jitteriness, and diaphoresis. These symptoms result from the low blood sugar levels. Flushed skin, dry mouth, and tented skin turgor (choice B) are more indicative of dehydration. Polyuria, polydipsia, and polyphagia (choice C) are classic symptoms of diabetes mellitus, not insulinomas. Hypertension, tachycardia, and feeling hot (choice D) are not typical symptoms of insulinomas.

2. The nurse is told in report that the client has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur?

• A. Second intercostal space, right sternal border
• B. Erb’s point
• C. Second intercostal space, left sternal border
• D. Fourth intercostal space, left sternal border

Correct answer: A

Rationale: The correct anatomical position for auscultating the murmur of aortic stenosis is the second intercostal space, right sternal border. This is where the aortic valve is best auscultated, and the murmur of aortic stenosis is heard most clearly. Choices B, C, and D are incorrect as the murmur of aortic stenosis is best heard at the second intercostal space on the right side of the sternum.

3. The nurse enters a client’s room and the client is demanding release from the hospital. The nurse reviews the client’s record and noted that the client was admitted 2 days ago for treatment of an anxiety disorder, and the admission was voluntary. Which intervention should the nurse initiate first?

• A. Telephone the client’s family and have them persuade the client to stay
• B. Have the client read and sign all the appropriate self-discharge papers
• C. Explain to the client that he cannot leave because he asked for treatment
• D. Notify the client’s healthcare provider of the client’s stated intent to leave the hospital

Correct answer: D

Rationale: The correct intervention for the nurse to initiate first is to notify the client’s healthcare provider of the client’s stated intent to leave the hospital. This action is crucial as it ensures that the client’s care and safety are appropriately managed. Option A is not the best choice as involving the family to persuade the client may not address the client's underlying concerns. Option B is incorrect because having the client sign self-discharge papers without further assessment is not appropriate. Option C is also incorrect as the client's request for treatment does not prevent them from leaving if they are deemed competent to make that decision.

4. The nurse prepares to administer digoxin (Lanoxin) to a newborn with a diagnosis of heart failure and notes that the apical rate is 140 beats per minute. Which nursing action is appropriate?

• A. Hold the medication
• B. Administer the digoxin
• C. Notify the healthcare provider
• D. Recheck the apical rate in 1 hour

Correct answer: B

Rationale: An apical rate of 140 bpm is within the normal range for a newborn. Digoxin is commonly used to treat heart failure by increasing the strength and efficiency of the heart's contractions. Since the heart rate is within the normal range, there is no need to hold the medication or notify the healthcare provider. Rechecking the apical rate in an hour is unnecessary as the heart rate is not alarming. Therefore, the appropriate nursing action is to administer the digoxin.

5. The client with peripheral vascular disease is being taught by the nurse. Which interventions should the nurse discuss with the client?

• A. Keep the area between the toes dry.
• B. Wear comfortable, well-fitting shoes.
• C. Cut toenails straight across.
• D. A, B

Correct answer: D

Rationale: The correct interventions for a client with peripheral vascular disease include keeping the area between the toes dry and wearing comfortable, well-fitting shoes. Choice A is correct as moisture between the toes can lead to skin breakdown and infection. Choice B is also correct as proper footwear helps prevent injury and promotes circulation. Choice C, cutting toenails straight across, is incorrect for peripheral vascular disease clients as cutting them in an arch can reduce the risk of ingrown toenails, which is important for clients with diabetes to prevent complications. Therefore, choices A and B are the most appropriate interventions for the client with peripheral vascular disease.

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