Nursing Elites

1. The healthcare provider is caring for a client with a chest tube. Which assessment finding requires immediate intervention?

• A. Intermittent bubbling in the water seal chamber.
• B. Drainage of 75 ml in the first hour post-insertion.
• C. Crepitus around the insertion site.
• D. Fluctuation of the water level in the water seal chamber with respiration.

Correct answer: C

Rationale: Crepitus (subcutaneous emphysema) around the insertion site can indicate air leakage, requiring immediate intervention to prevent complications such as pneumothorax. This assessment finding suggests that there may be a break in the chest tube system, leading to air entering the pleural space. Prompt intervention is crucial to prevent respiratory compromise and further complications.

2. What is the primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT)?

• A. No need for regular INR monitoring
• B. Lower risk of bleeding
• C. Fewer dietary restrictions
• D. Longer half-life

Correct answer: A

Rationale: The primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT) is that rivaroxaban does not require regular INR monitoring. This eliminates the need for frequent blood tests to adjust the dosage, making it more convenient for patients to manage their anticoagulant therapy.

3. A recently widowed middle-aged female client presents to the psychiatric clinic for evaluation and tells the nurse that she has 'little reason to live.' She describes one previous suicidal gesture and admits to having a gun in her home. To maintain the client's confidentiality and to help ensure her safety, which action is best for the nurse to implement?

• A. Encourage the client to remove the gun from her possession.
• B. Notify the client's healthcare provider of the availability of the weapon.
• C. Contact a person of the client's choosing to remove the weapon from the home.
• D. Call the local police department and have the weapon removed from the home.

Correct answer: C

Rationale: In this scenario, it is crucial to maintain the client's confidentiality while ensuring her safety. Contacting a person chosen by the client to remove the weapon from her home is the best course of action. This approach respects the client's autonomy and helps reduce the risk of harm without involving external authorities unnecessarily.

4. In which situation is it most important for the registered nurse (RN) working on a medical unit to provide direct supervision?

• A. A graduate nurse needs to access a client's implanted port to start an infusion of Ringer's Lactate.
• B. A postpartum nurse pulled to the unit needs to start a transfusion of packed red blood cells.
• C. A practical nurse is preparing to assist the healthcare provider with a lumbar puncture at the bedside.
• D. An unlicensed assistive personnel is preparing to weigh an obese bedfast client using a bed scale.

Correct answer: A

Rationale: Direct supervision is essential when a complex task, such as accessing an implanted port, is being performed by a less experienced healthcare provider, in this case, a graduate nurse. This oversight ensures patient safety and proper execution of the procedure, especially when it is the nurse's first time performing such a task.

5. The nurse is caring for four clients: Client A, who has emphysema and an oxygen saturation of 94%; Client B, with a postoperative hemoglobin of 8.7 g/dL; Client C, newly admitted with a potassium level of 3.8 mEq/L; and Client D, scheduled for an appendectomy with a white blood cell count of 15,000/mm3. What intervention should the nurse implement?

• A. Increase Client A's oxygen to 4 liters per minute via nasal cannula.
• B. Determine if Client B has two units of packed cells available in the blood bank.
• C. Ask the dietitian to add a banana to Client C's breakfast tray.
• D. Inform Client D that surgery is likely to be delayed until the infection is treated.

Correct answer: D

Rationale: A high white blood cell count, as seen in Client D, indicates infection, which may require postponing surgery to treat the infection adequately. It is crucial to address the underlying infection before proceeding with the appendectomy to prevent complications and ensure a successful surgical outcome.

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