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 to assess the dorsalis pedis pulse. The nurse palpates this pulse by placing the fingertips in which location?

• A. Behind the knee
• B. Lateral to the extensor tendon of the big toe
• C. In the groove between the malleolus and the Achilles tendon
• D. Below the inguinal ligament, halfway between the pubis and the anterior superior iliac spines

Correct answer: B

Rationale: The correct location to palpate the dorsalis pedis pulse is lateral to and parallel with the extensor tendon of the big toe. Choices A, C, and D describe the locations for other pulses - popliteal, posterior tibial, and femoral artery respectively. The popliteal pulse is found behind the knee, the posterior tibial pulse is located in the groove between the malleolus and the Achilles tendon, and the femoral artery is situated below the inguinal ligament, halfway between the pubis and the anterior superior iliac spines.

3. The LPN is preparing a client for discharge, and the discharge medications include phenobarbital. Which of these client statements would indicate a need for reinforced teaching about this medication?

• A. "I will need to avoid eating excessive leafy greens."?
• B. "It's best to take this medication with food."?
• C. "I can't wait to get back to my nightly glass of wine."?
• D. "I should try to take this medication at the same time every day."?

Correct answer: C

Rationale: The correct answer is, "I can't wait to get back to my nightly glass of wine,"? as phenobarbital should not be taken with alcohol as it is a barbiturate. Alcohol may increase the sedative effect, posing risks to the patient's safety. Choice A, "I will need to avoid eating excessive leafy greens,"? is unrelated to phenobarbital and not a cause for reinforced teaching. Choice B, "It's best to take this medication with food,"? is a general instruction and not specific to phenobarbital. Choice D, "I should try to take this medication at the same time every day,"? is a common recommendation for medication adherence but does not highlight a specific concern related to phenobarbital.

4. A male client is learning about testicular self-examination (TSE) from a nurse. Which statement should the nurse make to the client?

• A. 'A good time to examine the testicles is during or after you take a shower.'
• B. 'If you notice an enlarged testicle or a lump, you need to notify the physician.'
• C. 'The testicle is round and smooth. It feels firm and without lumps.'
• D. 'Perform a testicular exam monthly to detect early signs of testicular cancer.'

Correct answer: B

Rationale: The correct statement for the nurse to make to the client is 'If you notice an enlarged testicle or a lump, you need to notify the physician.' During a shower or bath is the best time to examine the testes because warm temperatures make the testes hang lower in the scrotum. The testes should feel round and smooth, without lumps. Self-examination should be performed monthly to detect any abnormalities early. The physician needs to be notified immediately if any abnormal findings are noticed. Choice A is incorrect because the best time for TSE is during or after a warm shower or bath, not just before. Choice C is incorrect as the testicle should feel round, smooth, and without lumps, not egg-shaped and lumpy. Choice D is incorrect as monthly self-examinations are recommended, not every 2 months.

5. During a health assessment, a nurse is assisting with gathering subjective data from a client and plans to ask the client about the medical history of the client's extended family. About which family members would the nurse ask the client?

• A. Aunts, uncles, grandparents, and cousins
• B. Foster children and their parents
• C. Wife's children from a previous marriage
• D. Wife and wife's parents

Correct answer: B

Rationale: The correct answer is 'Aunts, uncles, grandparents, and cousins.' When gathering medical history from the client's extended family, it is essential to inquire about relatives beyond the nuclear family, such as aunts, uncles, grandparents, and cousins, as they share genetic and environmental influences. Choice C, 'Wife's children from a previous marriage,' pertains to stepchildren, not extended family members. Choice B, 'Foster children and their parents,' involves individuals who are not biologically related to the client's family. Choice D, 'Wife and wife's parents,' focuses solely on immediate family members and excludes the client's extended family members, which are crucial for a comprehensive health assessment.

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