Nursing Elites

1. A male client with heart failure calls the clinic and reports that he cannot put his shoes on because they are too tight. Which additional information should the nurse obtain?

• A. What time he took his medication?
• B. Has his weight changed in the last several days?
• C. Is he still able to tighten his belt buckle?
• D. How many hours he slept last night?

Correct answer: B

Rationale: The correct answer is B: 'Has his weight changed in the last several days?' Sudden weight gain can indicate fluid retention, which is a common symptom of worsening heart failure. The inability to put on tight shoes can be due to fluid retention leading to swelling in the feet and ankles. Choices A, C, and D do not directly address the potential fluid retention issue and are less relevant in this scenario.

2. Twelve hours following a unilateral total knee replacement, a client reports being unable to sleep because of severe incisional pain. What is the best initial nursing action?

• A. Administer a prescribed sedative.
• B. Reposition the client for comfort.
• C. Apply ice packs to the surgical site.
• D. Instruct the client in the use of the prescribed patient-controlled analgesia (PCA) pump.

Correct answer: D

Rationale: Instructing the client in the use of the PCA pump is the best initial nursing action for managing severe incisional pain after knee replacement surgery. The PCA pump allows the client to self-administer pain medication effectively, promoting better pain management. Administering a sedative may mask the pain temporarily but doesn't address the root cause. Repositioning the client for comfort or applying ice packs may provide some relief but doesn't address the need for effective pain control as the PCA pump does.

3. Which intervention should the nurse include in the plan of care for a client who has a chest tube due to hemothorax?

• A. Keep the arm and shoulder of the affected side immobile at all times.
• B. Encourage the client to breathe deeply and cough at frequent intervals.
• C. Maintain the pleura vac slightly above the chest level.
• D. Ensure there is no fluctuation in the water seal.

Correct answer: B

Rationale: Encouraging deep breathing and coughing is vital for a client with a chest tube due to hemothorax as it helps prevent atelectasis and promotes lung expansion. Keeping the arm and shoulder immobile (Choice A) is not necessary for chest tube management. Maintaining the pleura vac slightly above the chest level (Choice C) is incorrect as the pleura vac should be kept below the chest level to facilitate drainage. Ensuring no fluctuation in the water seal (Choice D) is important, but it is not the priority intervention when compared to promoting lung expansion through deep breathing and coughing.

4. The healthcare provider prescribes the nonsteroidal anti-inflammatory drug (NSAID) naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, 'The pills don't seem to be working. They are not helping the pain at all.' Which factor should influence the nurse’s response?

• A. Noncompliance is probably impacting the optimum medication effectiveness.
• B. Drug dosage is inadequate and needs to be increased to four times a day.
• C. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream.
• D. NSAID response is variable, and another NSAID may be more effective.

Correct answer: D

Rationale: The correct answer is D. NSAID response can vary among individuals, and sometimes a different NSAID may be more effective for a specific client. In this case, since the current NSAID (naproxen) is not providing pain relief, it is reasonable to consider switching to another NSAID. Choice A is incorrect because there is no information provided to suggest noncompliance. Choice B is incorrect as increasing the dosage without assessing the response may lead to unnecessary side effects. Choice C is incorrect because although it may take time for NSAIDs to reach therapeutic levels, lack of pain relief after a month is a valid reason to consider changing the medication rather than waiting longer.

5. The nurse is reviewing blood pressure readings for a group of clients on a medical unit. Which client is at the highest risk for complications related to hypertension?

• A. Post-menopausal Caucasian female who overeats and is 20% above her ideal body weight.
• B. Young adult Hispanic female who has hemoglobin at 11 g/dl (110 g/L) and drinks beer daily.
• C. Older adult who consumes a diet of smoked, cured, and pickled foods.
• D. Middle-aged African-American male who has a serum creatinine level of 2.9 mg/dL (256.4 micromol/L).

Correct answer: D

Rationale: The correct answer is D. An elevated serum creatinine level indicates kidney damage, which significantly increases the risk of complications from hypertension. High blood pressure can damage the kidneys over time, leading to impaired kidney function. Choices A, B, and C do not directly correlate with increased risk of complications related to hypertension. Choice A focuses on obesity and overeating, Choice B on anemia and alcohol consumption, and Choice C on a diet high in sodium and nitrates, none of which are as directly related to hypertension complications as kidney damage.

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