Nursing Elites

1. A patient is being visited at home by a healthcare professional. The patient has been taking Naproxen for back pain. Which statement made by the patient most indicates that the healthcare professional needs to contact the physician?

• A. I get an upset stomach if I don't take Naproxen with my meals.
• B. My back pain right now is about a 3/10.
• C. I get occasional headaches since taking Naproxen
• D. I have ringing in my ears.

Correct answer: D

Rationale: The correct answer is 'I have ringing in my ears.' Ringing in the ears is a severe adverse effect of Naproxen, indicating potential toxicity. This symptom warrants immediate medical attention. Choices A, B, and C are less concerning and do not directly indicate a severe adverse effect or toxicity related to Naproxen. Upset stomach, mild back pain, and occasional headaches are common side effects that may not require immediate physician contact.

2. A patient in the cardiac care unit is taking bumetanide (Bumex) for heart issues and is also diagnosed with Parkinson's Disease. An unlicensed assistive personnel is assisting with feeding the patient. Which of these foods should the nurse stress for the patient to eat most?

• A. Foods containing the least amount of salt
• B. Foods containing the most amount of potassium
• C. Foods containing the most amount of calories
• D. Foods containing the most amount of fiber

Correct answer: B

Rationale: Bumex is a loop diuretic that can lead to hypokalemia (low potassium levels). Hypokalemia can be dangerous and lead to various complications. To prevent a hypokalemic crisis, it is crucial to ensure an adequate intake of potassium. Therefore, the nurse should stress the patient to eat foods rich in potassium. Choices A, C, and D are not the priority in this situation. While monitoring salt intake is important in cardiac patients, the immediate concern with bumetanide use is the risk of hypokalemia, making choice B the most appropriate option.

3. While auscultating a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?

• A. Inspiratory crackles at the bases
• B. Expiratory wheezes in both lungs
• C. Abnormal lung sounds in the apices of both lungs
• D. Pleural friction rub in the right and left lower lobes

Correct answer: A

Rationale: The correct answer is 'Inspiratory crackles at the bases.' Crackles are low-pitched, bubbling sounds typically heard during inspiration, which aligns with the nurse's finding. Expiratory wheezes are high-pitched sounds and are not consistent with the described auscultation findings. The lower third of both lungs refers to the bases, not the apices, so option C is incorrect. Pleural friction rubs are grating sounds heard during both inspiration and expiration, unlike the described finding of only hearing the sounds during inhalation in the lower third of both lungs.

4. The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

• A. Oxygen saturation is 88%.
• B. Blood pressure is 145/90 mm Hg.
• C. Respiratory rate is 22 breaths/minute when lying flat.
• D. Pain level is 5 (on a 0 to 10 scale) with a deep breath.

Correct answer: A

Rationale: The correct answer is 'Oxygen saturation is 88%.' Following a thoracentesis, oxygen saturation should improve. A saturation of 88% suggests a potential complication like pneumothorax. While the other assessment findings are important, the priority is to address the low oxygen saturation to prevent further complications. High blood pressure and respiratory rate may also need attention, but the immediate concern is the oxygen saturation level. Pain level, though significant for the patient's comfort, takes lower priority compared to the potential life-threatening issue of hypoxia.

5. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?

• A. Unequal leg length
• B. Limited adduction
• C. Diminished femoral pulses
• D. Symmetrical gluteal folds

Correct answer: A

Rationale: In developmental dysplasia of the hip (DDH), one of the key findings is unequal leg length. This occurs due to the dislocation of the hip joint, where the ball is loose in the socket. Limited adduction, the inability to bring the hip and knee towards the midline of the body, is also a common finding in DDH. Diminished femoral pulses are not typically associated with DDH, as it primarily affects the skeletal structure rather than vascular supply. Symmetrical gluteal folds are normal in infants and do not indicate DDH, as asymmetry in gluteal folds can be a sign of hip dislocation.

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