Nursing Elites

1. When assessing the carotid artery of a client with cardiovascular disease, what action should a nurse perform?

• A. Palpating the carotid artery in the upper third of the neck
• B. Palpating both arteries simultaneously to compare amplitude
• C. Listening to the carotid artery, using the bell of the stethoscope to assess for bruits
• D. Instructing the client to take slow, deep breaths while the nurse listens to the carotid artery

Correct answer: C

Rationale: When assessing the carotid artery of a client with cardiovascular disease, the nurse should listen to the carotid artery using the bell of the stethoscope to assess for bruits. This is crucial in detecting abnormal sounds that may indicate underlying pathology. Palpating the carotid artery in the upper third of the neck can trigger a vagal response, leading to a decrease in heart rate, which is undesirable. Palpating both arteries simultaneously can disrupt blood flow to the brain. Instructing the client to take slow, deep breaths is unnecessary and not a standard practice during carotid artery assessment.

2. A nurse is preparing a female client for a rectal examination. Into which position does the nurse assist the client?

• A. Supine
• B. Standing
• C. Lithotomy
• D. Left lateral

Correct answer: D

Rationale: For a rectal examination in a female client, the nurse should assist the client into the left lateral position. This position allows easier access to the rectal area, facilitating the examination. The lithotomy position is used for examining the genitalia and rectum in females, not solely for a rectal examination. The standing position is not appropriate for a rectal examination as it does not provide the necessary access. The supine position would hinder the effectiveness of a rectal examination as it does not optimize access to the rectal area.

3. Ms. Petty is having difficulty falling asleep. Which of the following measures promote sleep?

• A. exercising vigorously for 20 minutes each night beginning at 9:30 p.m.
• B. taking a cool shower and drinking a hot cup of tea
• C. watching TV nightly until midnight
• D. getting a back rub and drinking a glass of warm milk

Correct answer: D

Rationale: The correct answer is getting a back rub and drinking a glass of warm milk. These measures are relaxation techniques that can help promote sleep by calming the body and mind. Exercising vigorously right before bedtime, as mentioned in choice A, can increase arousal and make it harder to fall asleep. Choice B, taking a cool shower and drinking a hot cup of tea, involves temperature changes that might not be conducive to sleep. Watching TV until midnight, as in choice C, exposes the individual to blue light and mental stimulation, both of which can disrupt the natural sleep-wake cycle.

4. An assessment of the skull of a normal 10-month-old baby should identify which of the following?

• A. closure of the posterior fontanel.
• B. closure of the anterior fontanel.
• C. overlap of cranial bones.
• D. ossification of the sutures

Correct answer: A

Rationale: The correct answer is the closure of the posterior fontanel. By 10 months of age, the posterior fontanel should be closed. The anterior fontanel typically closes around 12-18 months of age. Overlapping of cranial bones is not a normal finding and may indicate craniosynostosis, a condition where the sutures close too early. Ossification of the sutures is also not a normal finding in a 10-month-old baby as the sutures should remain open to allow for the growth of the skull.

5. A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:

• A. naloxone (Narcan)
• B. labetalol (Normodyne)
• C. neostigmine (Prostigmin)
• D. thiothixene (Navane)

Correct answer: A

Rationale: In this scenario, the client is experiencing respiratory depression due to opiate overdose. Naloxone (Narcan) is an opioid antagonist that can rapidly reverse the effects of opiates by competitively binding to opioid receptors and displacing the opiates. This action can restore normal respiration and consciousness. Labetalol (Normodyne) is a non-selective beta-blocker used to manage hypertension, not opioid-induced respiratory depression. Neostigmine (Prostigmin) is a cholinesterase inhibitor used to reverse neuromuscular blockade, not opioid overdose. Thiothixene (Navane) is an antipsychotic medication used to manage psychotic disorders, not opioid toxicity.

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