Nursing Elites

1. A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the best for the nurse to provide?

• A. Check it again in one month, and if it is still there schedule an appointment.
• B. Most lumps are benign, but it is always best to come in for an examination.
• C. Try not to worry too much about it, because usually, most lumps are benign.
• D. If you are in your menstrual period it is not a good time to check for lumps.

Correct answer: B

Rationale: The nurse advising the client to come in provides the best response because it addresses the client's anxiety most effectively and encourages prompt and immediate action for a potential problem.

2. A nurse is assessing the chest tube drainage system of a postoperative client who has undergone a right upper lobectomy. The closed drainage system contains 300 mL of bloody drainage, and the nurse notes intermittent bubbling in the water seal chamber. One hour after the initial assessment, the nurse notes that the bubbling in the water seal chamber is now constant, and the client appears dyspneic. On the basis of these findings, the nurse should first assess:

• A. The client’s vital signs
• B. The amount of drainage
• C. The client’s lung sounds
• D. The chest tube connections

Correct answer: D

Rationale: The client’s dyspnea is most likely related to an air leak caused by a loose connection in the chest tube system. Checking the chest tube connections should be the initial action because correcting an air leak can quickly resolve the client's symptoms. If a leak is found and corrected, the dyspnea should improve. Assessing the client’s vital signs (Option A) is important, but addressing the potential cause of dyspnea takes precedence. Monitoring the amount of drainage (Option B) is necessary for assessing the client's overall condition, but in this case, the dyspnea is likely due to an air leak. Checking the client’s lung sounds (Option C) is essential for respiratory assessment, but addressing the air leak should be the immediate priority to ensure adequate lung expansion and oxygenation.

3. A patient is diagnosed with Mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Erythromycin (E-Mycin)
• D. Fidaxomicin (Dificid)

Correct answer: C

Rationale: Erythromycin is the drug of choice for treating Mycoplasma pneumonia. Mycoplasma pneumonia is typically sensitive to macrolide antibiotics, with erythromycin being one of the first-line agents. Azithromycin and clarithromycin are also effective in treating Mycoplasma pneumonia, but erythromycin is specifically mentioned as the drug of choice in this context. Fidaxomicin, on the other hand, is not indicated for the treatment of Mycoplasma pneumonia and is primarily used to treat Clostridium difficile infections.

4. A client is undergoing hemodialysis. The client’s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

• A. Adjust the rate of extracorporeal blood flow.
• B. Place the client in the Trendelenburg position.
• C. Administer a 250-mL bolus of normal saline.
• D. All of the above

Correct answer: D

Rationale: During hemodialysis, a drop in blood pressure can occur due to fluid removal. To maintain blood pressure, the nurse should consider adjusting the rate of extracorporeal blood flow to optimize fluid removal without causing hypotension. Placing the client in the Trendelenburg position can help improve venous return and cardiac output. Administering a bolus of normal saline can help increase intravascular volume and support blood pressure. Therefore, all the actions listed in choices A, B, and C are appropriate measures to maintain blood pressure during hemodialysis. Choice D, 'All of the above,' is the correct answer as it encompasses all the relevant actions to address the dropping blood pressure effectively. Choices A, B, and C, when implemented together, can help manage hypotension during hemodialysis.

5. In a patient with diabetes mellitus, which of the following is a sign of hypoglycemia?

• A. Polydipsia.
• B. Polyuria.
• C. Sweating.
• D. Dry skin.

Correct answer: C

Rationale: Sweating is a common sign of hypoglycemia in diabetic patients. When blood sugar levels drop too low, the body releases stress hormones like adrenaline, which can cause sweating as a response to the perceived danger. Polydipsia (excessive thirst) and polyuria (excessive urination) are actually more commonly associated with hyperglycemia, not hypoglycemia. Dry skin is not typically a sign of hypoglycemia.

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