Nursing Elites

1. A client post-thyroidectomy is being monitored for signs of hypocalcemia. Which of the following symptoms should the nurse be most concerned about?

• A. Tingling in the hands and around the mouth.
• B. Nausea and vomiting.
• C. Constipation.
• D. Bradycardia.

Correct answer: A

Rationale: The correct answer is A: Tingling in the hands and around the mouth. This symptom is a classic sign of hypocalcemia, which can occur after thyroidectomy if the parathyroid glands were inadvertently damaged during surgery. Nausea and vomiting (Choice B) are not specific to hypocalcemia. Constipation (Choice C) is not a typical symptom of hypocalcemia. Bradycardia (Choice D) is more commonly associated with hypothyroidism rather than hypocalcemia.

2. At one minute after birth, an infant is crying, has a heart rate of 140, has acrocyanosis, resists the suction catheter, and keeps his arms extended and his legs flexed. What is the Apgar score?

• A. 4
• B. 6
• C. 8
• D. 10

Correct answer: C

Rationale: The Apgar score is based on five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color. In this case, the infant has a heart rate over 100 (2 points), is crying (2 points indicating good respiratory effort), resists the catheter (2 points for good reflex irritability), but has acrocyanosis (partial point deduction of 1). Thus, the Apgar score at one minute after birth would be 8. Choice A is incorrect as the given signs indicate a higher score. Choice B is incorrect as the signs described support a score above 6. Choice D is incorrect as it represents a perfect score which is not the case here due to acrocyanosis.

3. When caring for a patient with a chest tube, which nursing action is most important?

• A. Clamping the chest tube every 2 hours to prevent air leaks
• B. Keeping the drainage system below chest level
• C. Emptying the drainage system every hour to prevent backflow
• D. Removing the chest tube when drainage decreases significantly

Correct answer: B

Rationale: The most crucial nursing action when caring for a patient with a chest tube is to keep the drainage system below chest level (choice B). This position helps ensure proper drainage and prevents backflow of fluid or air into the pleural space, promoting optimal functioning of the chest tube. Clamping the chest tube every 2 hours (choice A) is incorrect as it can obstruct the drainage system and lead to complications. Emptying the drainage system every hour (choice C) is unnecessary unless there are specific clinical indications. Removing the chest tube when drainage decreases significantly (choice D) is also incorrect as the decision should be based on overall clinical assessment rather than drainage amount alone.

4. The UAP reports to the PN that a client refused to bathe for the third consecutive day. Which action is best for the PN to take?

• A. Explain the importance of good hygiene to the client
• B. Ask family members to encourage the client to bathe
• C. Reschedule the bath for the following day
• D. Ask the client why the bath was refused

Correct answer: D

Rationale: The best action for the PN to take when a client refuses to bathe is to ask the client why the bath was refused. Understanding the client's reasons for refusing a bath is crucial as it helps to address any underlying issues, such as fear, discomfort, or physical limitations. By communicating directly with the client, the PN can provide appropriate care tailored to the client's needs. Choices A, B, and C do not directly address the root cause of the refusal and may not effectively resolve the issue.

5. The PN and UAP enter a client's room and find the client lying on the bed. The PN determines that the client is unresponsive. Which instruction should the PN give the UAP first?

• A. Obtain emergency help
• B. Feel for a carotid pulse
• C. Bring a glucometer to the room
• D. Check the blood pressure

Correct answer: A

Rationale: The correct answer is to instruct the UAP to obtain emergency help first. When a client is unresponsive, it could indicate a life-threatening condition that requires immediate intervention. Ensuring emergency help is on the way is the priority to address the potentially critical situation. Feeling for a carotid pulse, bringing a glucometer, or checking the blood pressure are important assessments but should come after taking steps to secure immediate assistance.

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