Nursing Elites

1. When assessing a client with a chest tube connected to suction, which observation indicates that the chest tube is functioning properly?

• A. Continuous bubbling in the water seal chamber.
• B. Intermittent bubbling in the suction control chamber.
• C. No fluctuation in the water seal chamber.
• D. Steady bubbling in the suction control chamber.

Correct answer: D

Rationale: Steady bubbling in the suction control chamber is the correct observation that indicates the chest tube is functioning properly. This steady bubbling signifies that the suction is actively maintaining the desired pressure level within the system, ensuring proper drainage and lung re-expansion. Continuous bubbling in the water seal chamber, intermittent bubbling in the suction control chamber, or no fluctuation in the water seal chamber are not indicative of optimal chest tube function and may require further assessment or intervention.

2. A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?

• A. Acute pancreatitis
• B. Mesenteric ischemia
• C. Peptic ulcer disease
• D. Diverticulitis

Correct answer: B

Rationale: The sudden onset of severe abdominal pain in a patient with atrial fibrillation, along with a soft abdomen and minimal tenderness on examination, suggest mesenteric ischemia due to embolic occlusion of the mesenteric arteries. This condition is characterized by a sudden and severe decrease in blood flow to the intestines, leading to abdominal pain and tenderness. Acute pancreatitis typically presents with epigastric pain that may radiate to the back, accompanied by elevated serum amylase and lipase levels. Peptic ulcer disease and diverticulitis usually do not manifest with the sudden onset of severe abdominal pain as described in the case.

3. A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?

• A. Nitrofurantoin (Macrodantin) orally.
• B. Erythropoietin (Epogen) intravenously.
• C. Kayexalate retention enema.
• D. Azathioprine (Imuran) orally.

Correct answer: C

Rationale: In acute renal failure with high serum potassium levels, the healthcare provider is likely to prescribe a Kayexalate retention enema. Kayexalate is a medication used to lower elevated potassium levels by promoting potassium excretion through the gastrointestinal tract, thus aiding in the management of hyperkalemia in clients with renal failure.

4. The mental health nurse observes that a female client with delusional disorder carries some of her belongings with her because she believes that others are trying to steal them. Which nursing action will promote trust?

• A. Explain that distrust is related to feeling anxious.
• B. Initiate short, frequent contacts with the client.
• C. Explain that these beliefs are related to her illness.
• D. Offer to keep the belongings at the nurse's desk.

Correct answer: B

Rationale: Initiating short, frequent contacts with the client is the most appropriate action to promote trust. This approach helps build trust and rapport, addressing the client's need for security. By maintaining regular contact, the nurse can provide reassurance and support, which can help alleviate the client's anxiety related to her delusional beliefs. Choice A does not directly address the client's need for trust and security. Choice C focuses on the client's illness but does not actively address building trust. Choice D, offering to keep the belongings at the nurse's desk, may not be well-received by the client and could potentially worsen her anxiety and distrust.

5. A client with type 2 diabetes mellitus presents to the clinic with a foot ulcer. Which instruction should the nurse provide to the client to promote healing of the ulcer?

• A. Apply a heating pad to the ulcer twice daily.
• B. Wear tight-fitting shoes to protect the ulcer.
• C. Keep the ulcer clean and dry.
• D. Limit walking to reduce pressure on the ulcer.

Correct answer: C

Rationale: The correct answer is C: "Keep the ulcer clean and dry." For clients with diabetes mellitus, it is crucial to maintain foot ulcers clean and dry to prevent infection and promote healing. Moist environments can lead to bacterial growth and delay healing. Applying a heating pad (Choice A) can increase the risk of burns and further damage the ulcer. Wearing tight-fitting shoes (Choice B) can cause friction and pressure on the ulcer, hindering the healing process. Limiting walking (Choice D) excessively can affect circulation and delay healing. Therefore, the nurse should instruct the client to keep the ulcer clean and dry for optimal wound care management.

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