Nursing Elites

1. A male client attends a community support program for mentally impaired and chemically abusing clients. The client tells the PN that his drugs of choice are cocaine and heroin. What is the greatest health risk for this client?

• A. Hypertension
• B. Hepatitis
• C. Glaucoma
• D. Diabetes

Correct answer: B

Rationale: The correct answer is B: Hepatitis. Hepatitis is the greatest health risk for this client due to the potential for contracting the disease through needle-sharing, common among drug users. This can lead to serious liver complications. While hypertension, glaucoma, and diabetes are all important health concerns, they are not directly associated with the drug abuse mentioned in the scenario.

2. During an inspection of a client's fingernails, the nurse notices a suspected abnormality in the shape and character of the nails. Which finding should the nurse document?

• A. Clubbed nails
• B. Splinter hemorrhages
• C. Longitudinal ridges
• D. Koilonychia or spoon nails

Correct answer: A

Rationale: Clubbed nails are a significant finding in clients with chronic hypoxia or lung disease. This abnormality is characterized by an increased curvature of the nails and softening of the nail bed. It can indicate underlying health conditions such as respiratory or cardiovascular issues. Splinter hemorrhages (B) are small areas of bleeding under the nails, typically associated with infective endocarditis. Longitudinal ridges (C) are often a normal age-related change in the nails. Koilonychia or spoon nails (D) present as a concave shape of the nails and are commonly seen in clients with iron deficiency anemia or hemochromatosis. Therefore, documenting clubbed nails is the most relevant abnormality to report and investigate further.

3. After adding feeding solution to a client's tube feeding system as seen in the picture, what action should the PN take next?

• A. Remove the air from the solution bag
• B. Obtain a piston syringe and irrigation set
• C. Record the solution added as fluid intake
• D. Calculate the rate of flow of the solution

Correct answer: B

Rationale: After adding feeding solution, obtaining a piston syringe and irrigation set is necessary to flush the feeding tube and ensure patency before starting the feeding. This helps prevent blockages and ensures proper delivery of the nutritional solution. Option A is incorrect because removing air from the solution bag is not the immediate next step after adding the feeding solution. Option C is incorrect as recording the solution added as fluid intake is important but not the immediate next step. Option D is incorrect as calculating the rate of flow of the solution is not the next step after adding the feeding solution.

4. A client who had a hip replacement is being prepared for discharge. What should the nurse include in the discharge teaching to prevent hip dislocation?

• A. Avoid crossing your legs at the knees or ankles.
• B. Do not sleep on the side of the hip that was operated on.
• C. Sit in high chairs and keep your knees higher than your hips.
• D. Do not bend forward at the waist to pick up objects.

Correct answer: A

Rationale: The correct answer is A: 'Avoid crossing your legs at the knees or ankles.' Crossing legs at the knees or ankles can cause excessive stress on the new hip joint, leading to a risk of dislocation. Choice B is incorrect because sleeping on the side of the operated hip can also increase the risk of dislocation. Choice C is incorrect as sitting in low chairs with knees higher than hips is a recommended position to prevent hip dislocation. Choice D is incorrect because bending forward at the waist to pick up objects can strain the hip joint and increase the risk of dislocation.

5. A homeless male client with a history of alcohol abuse had a CVA 10 years ago that resulted in left hemiparesis. Today he is brought to the clinic reporting pain in his left leg. He is afebrile, has 4+ pitting edema in the lower left leg, and has minimal swelling of the right leg. Which action should the PN implement first?

• A. Obtain a blood alcohol test
• B. Inspect legs for infection or trauma
• C. Complete a mental status exam
• D. Inquire about dietary salt intake

Correct answer: B

Rationale: Inspecting the legs for infection or trauma is the priority to assess the cause of the pain and edema, which could indicate deep vein thrombosis or cellulitis. Checking for signs of infection or trauma is crucial in this scenario to rule out potentially serious conditions. Obtaining a blood alcohol test, completing a mental status exam, or inquiring about dietary salt intake can be considered after addressing the immediate concern of identifying any infection or trauma in the leg.

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