Nursing Elites

1. A client with a history of myocardial infarction is admitted with chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG). An electrocardiogram should be performed first to assess for cardiac ischemia in a client with a history of myocardial infarction and chest pain. This test provides immediate information about the heart's electrical activity. Choice B, Chest X-ray, is used to visualize the structures of the chest, including the heart and lungs, but it does not directly assess for cardiac ischemia. Choice C, Arterial blood gases (ABGs), measures the oxygen and carbon dioxide levels in the blood and assesses acid-base balance, which is not the primary concern in this scenario. Choice D, Echocardiogram, is an ultrasound of the heart that provides information about the heart's structure and function, but it is not the initial diagnostic test for assessing cardiac ischemia in this situation.

2. The nurse is caring for a client with a tracheostomy who has thick, tenacious secretions. Which intervention should the nurse implement first?

• A. Encourage fluid intake to thin secretions.
• B. Administer a mucolytic agent.
• C. Increase humidity in the client's room.
• D. Perform deep suctioning as needed.

Correct answer: C

Rationale: Increasing humidity in the client's room is the first priority in managing thick, tenacious secretions in a client with a tracheostomy to facilitate airway clearance. This intervention helps to moisten secretions, making them easier to clear. Encouraging fluid intake (Choice A) can be beneficial, but increasing humidity should be addressed first. Administering a mucolytic agent (Choice B) and performing deep suctioning (Choice D) are interventions that can be considered after addressing humidity if necessary, but they are not the initial priority.

3. Which instruction is most important for a client who receives a new plan of care to treat osteoporosis?

• A. Start a weight-bearing exercise plan.
• B. Increase consumption of foods rich in calcium.
• C. Arrange a bone density test every year.
• D. Stay upright after taking the medication.

Correct answer: D

Rationale: The correct answer is D: 'Stay upright after taking the medication.' This instruction is crucial for clients receiving medications like bisphosphonates to prevent esophageal irritation or erosion. While weight-bearing exercises (choice A) are important for bone health, staying upright after medication intake takes precedence. Increasing calcium-rich foods (choice B) is beneficial but not the most important immediate instruction. Scheduling bone density tests (choice C) is necessary for monitoring osteoporosis but is not as critical as staying upright after medication.

4. A client with chronic renal failure (CRF) is placed on a protein-restricted diet. Which nutritional goal supports this dietary change?

• A. Reduce production of urea nitrogen (BUN)
• B. Decrease the risk of hyperkalemia
• C. Promote healing of injured nephrons
• D. Promote the elimination of albumin

Correct answer: A

Rationale: The correct answer is A: Reduce production of urea nitrogen (BUN). A protein-restricted diet is essential for clients with chronic renal failure to decrease the production of urea nitrogen, as the kidneys cannot effectively excrete it. This helps in managing the accumulation of waste products in the body. Choices B, C, and D are incorrect. Choice B is not directly related to a protein-restricted diet but focuses on managing potassium levels. Choice C is not a direct nutritional goal of a protein-restricted diet but aims at supporting kidney function. Choice D is not a target of a protein-restricted diet but relates more to managing protein loss in the urine.

5. When finding a client sitting on the floor, the nurse calls for help from the unlicensed assistive personnel (UAP). Which task should the nurse ask the UAP to do?

• A. Check for any abrasions or bruises.
• B. Help the client to stand.
• C. Get a blood pressure cuff.
• D. Report the fall to the nurse-manager.

Correct answer: C

Rationale: The correct task for the nurse to ask the unlicensed assistive personnel (UAP) to do in this situation is to "Get a blood pressure cuff." This is important because assessing the client's vital signs, including blood pressure, is crucial after a fall to ensure there are no underlying issues like hypotension. Choices A and B may be important tasks for the nurse to perform as part of the assessment and care of the client. However, in this scenario, the immediate concern should be to check the client's blood pressure. Choice D is not the most urgent task at this time, as assessing the client's condition takes precedence.

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