Nursing Elites

1. A client who wears glasses is under the care of a nurse. Which of the following actions should the nurse take?

• A. Store the glasses in a labeled case.
• B. Clean the glasses with hot water
• C. Clean the glasses with a paper towel.
• D. Store the glasses on the bedside table.

Correct answer: A

Rationale: It is essential for the nurse to store the client's glasses in a labeled case to ensure they are kept safe and protected from damage. Storing them in a case helps prevent scratches, breakage, or misplacement. This practice promotes proper eyewear hygiene and ensures the client has their glasses readily available when needed. Cleaning the glasses with hot water or a paper towel can potentially damage the lenses or frames. Storing the glasses on the bedside table increases the risk of misplacement or damage.

2. When a chest tube is accidentally removed from a client, which of the following actions should the nurse NOT take first?

• A. Obtain a chest x-ray
• B. Apply sterile gauze to the insertion site
• C. Place tape around the insertion site
• D. Assess respiratory status

Correct answer: B

Rationale: When a chest tube is accidentally removed, the priority action for the nurse is to immediately seal the insertion site with a gloved hand, a sterile occlusive dressing, or petroleum gauze to prevent air from entering the pleural space and causing a pneumothorax. Applying sterile gauze to the insertion site is not the correct initial action. The first step is to prevent respiratory compromise by ensuring the site is sealed. Therefore, the nurse should not apply sterile gauze to the insertion site first.

3. Which pulse's absence may not be a significant finding when a patient is admitted to the hospital?

• A. Apical
• B. Radial
• C. Pedal
• D. Femoral

Correct answer: C

Rationale: The absence of the pedal pulse may not be significant if the patient has poor peripheral circulation or if the healthcare provider is focused on other pulse points. The pedal pulse is often weaker and may not always be palpable due to various factors, making its absence less concerning in certain situations. However, the absence of other pulses like radial or femoral pulses may indicate more critical conditions and require immediate attention.

4. A client is receiving brachytherapy for treatment of prostate cancer. Which of the following actions should the nurse take?

• A. Cleanse equipment before removal from the client's room.
• B. Limit the client's visitors to 30 minutes per day.
• C. Discard the client's linens in a double bag.
• D. Discard the radioactive source in a biohazard bag

Correct answer: D

Rationale: When caring for a client receiving brachytherapy, it is crucial to handle radioactive sources appropriately. Discarding the radioactive source in a biohazard bag is essential to prevent exposure to radiation. Cleaning equipment before removal, limiting client's visitors, or discarding linens in a double bag are not specific to the management of radioactive sources in brachytherapy.

5. A healthcare professional is reviewing the laboratory results of a client who has rheumatoid arthritis. Which of the following findings should the healthcare professional report to the provider?

• A. WBC count 8,000/mm�
• B. Platelets 150,000/mm�
• C. Aspartate aminotransferase 10 units/L
• D. Erythrocyte sedimentation rate 75 mm/hr

Correct answer: D

Rationale: In clients with rheumatoid arthritis, an elevated erythrocyte sedimentation rate (ESR) is a common finding and indicates inflammation in the body. A high ESR value suggests active disease activity and potential joint damage. Therefore, the healthcare professional should report an ESR of 75 mm/hr to the provider for further evaluation and management of the client's rheumatoid arthritis.

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