Nursing Elites

1. An ambulatory clinic nurse is interviewing a client who is complaining of flu-like symptoms. The client suddenly develops chest pain. Which question best assists the nurse in discriminating pain caused by a non-cardiac problem?

• A. Can you describe the pain to me?
• B. Have you ever experienced this pain before?
• C. Does the pain get worse when you breathe in?
• D. Can you rate the pain on a scale of 1 to 10, with 10 being the worst?

Correct answer: C

Rationale: The correct answer is C. Pain that worsens with breathing in can indicate pleuritic chest pain, which is non-cardiac in nature. This specific question helps in differentiating non-cardiac causes from cardiac causes of chest pain, as cardiac pain typically does not worsen with breathing. Choices A, B, and D are less specific in discriminating between cardiac and non-cardiac chest pain.

2. A client has a new prescription for furosemide. Which of the following statements should the nurse include in the teaching?

• A. Take the medication in the morning.
• B. Monitor for muscle weakness.
• C. Eat foods high in potassium.
• D. Expect weight gain.

Correct answer: C

Rationale: The correct statement that the nurse should include in the teaching for a client prescribed furosemide is to eat foods high in potassium. Furosemide can lead to potassium depletion (hypokalemia) due to increased urine output. Consuming potassium-rich foods like bananas, oranges, spinach, and potatoes can help prevent this electrolyte imbalance. Choices A, B, and D are incorrect because taking furosemide in the morning, monitoring for muscle weakness, and expecting weight gain are not directly related to the potential side effects or necessary dietary adjustments when taking furosemide.

3. The client with myocardial infarction should reduce intake of saturated fat and cholesterol. Which food items from the dietary menu would assist the nurse in helping the client comply with diet therapy?

• A. Cheeseburger, pan-fried potatoes, whole kernel corn, sherbet
• B. Pork chop, baked potato, cauliflower in cheese sauce, ice cream
• C. Baked haddock, steamed broccoli, herbed rice, sliced strawberries
• D. Spaghetti and sweet sausage in tomato sauce, vanilla pudding (with 4% milk)

Correct answer: C

Rationale: Option C, which includes baked haddock, steamed broccoli, herbed rice, and sliced strawberries, is the most appropriate choice for a client with myocardial infarction looking to reduce saturated fat and cholesterol intake. This meal is low in saturated fats and cholesterol, making it a heart-healthy option that aligns with the dietary recommendations for such clients. Choices A, B, and D contain foods high in saturated fats and cholesterol, which are not suitable for a client with myocardial infarction trying to adhere to a diet therapy aimed at reducing these components.

4. The LPN/LVN is assisting in caring for a client in the telemetry unit who is receiving an intravenous infusion of 1000 mL of 5% dextrose with 40 mEq of potassium chloride. Which occurrence observed on the cardiac monitor indicates the presence of hyperkalemia?

• A. Tall, peaked T waves
• B. ST segment depressions
• C. Shortened P-R intervals
• D. Shortening of the QRS complex

Correct answer: A

Rationale: In hyperkalemia, tall, peaked T waves are a distinct ECG finding. These T waves can be seen as a result of increased serum potassium levels, affecting the repolarization phase of the cardiac action potential. It is crucial for healthcare providers to recognize this ECG change promptly as hyperkalemia can lead to serious cardiac arrhythmias and complications. ST segment depressions, shortened P-R intervals, and shortening of the QRS complex are not typically associated with hyperkalemia. ST segment depressions are more indicative of myocardial ischemia or infarction. Shortened P-R intervals may be seen in conditions like Wolff-Parkinson-White syndrome. Shortening of the QRS complex is associated with conditions affecting the conduction system of the heart, such as bundle branch blocks.

5. A client with peptic ulcer disease is being taught about managing the disorder. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should take NSAIDs for pain relief.'
• B. 'I should avoid drinking alcohol.'
• C. 'I should eat small, frequent meals.'
• D. 'I should drink milk to coat my stomach.'

Correct answer: B

Rationale: The correct answer is B. Avoiding alcohol is crucial in managing peptic ulcer disease as it helps prevent irritation and further damage to the stomach lining. Alcohol can worsen symptoms and hinder the healing process in individuals with this condition. Choice A is incorrect because NSAIDs can worsen peptic ulcers by irritating the stomach lining. Choice C is a correct dietary recommendation for managing peptic ulcer disease as it helps reduce stomach acid secretion and promotes healing. Choice D is incorrect as milk may temporarily soothe ulcer pain, but it can stimulate acid production and worsen symptoms in the long run.

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