Nursing Elites

1. The healthcare provider is caring for a client with a chest tube. Which observation indicates that the chest tube is functioning effectively?

• A. Continuous bubbling in the water-seal chamber.
• B. Intermittent bubbling in the suction control chamber.
• C. No fluctuation (tidaling) in the water-seal chamber.
• D. Drainage of clear, pale yellow fluid from the chest tube.

Correct answer: B

Rationale: Intermittent bubbling in the suction control chamber is the correct observation indicating effective functioning of the chest tube. This bubbling signifies that the suction system is working correctly and maintaining the desired negative pressure in the pleural space. Continuous bubbling in the water-seal chamber suggests an air leak, which is not a normal finding. No fluctuation (tidaling) in the water-seal chamber may indicate a blockage or lack of communication between the pleural space and the water-seal, which is not ideal. Drainage of clear, pale yellow fluid from the chest tube is a normal finding, but it does not specifically indicate the effectiveness of the chest tube function.

2. The healthcare provider is inspecting the external eye structures of a client. Which finding is a normal racial variation?

• A. Blue sclerae.
• B. Brown macules on the sclerae.
• C. Slightly yellow sclerae in an African-American client.
• D. Conjunctival pallor.

Correct answer: C

Rationale: The slightly yellow color of the sclera is a normal racial variation found in the African-American population. Blue sclerae (Choice A) are associated with osteogenesis imperfecta, not a normal racial variation. Brown macules on the sclerae (Choice B) may indicate issues like melanoma or melanosis but are not a normal racial variation. Conjunctival pallor (Choice D) suggests anemia or decreased blood flow but is not a normal racial variation.

3. During which home visit performed by a registered nurse or a practical nurse can the home healthcare agency expect Medicare reimbursement for documenting a skilled care service provided?

• A. 13-18 years of age
• B. 11-12 years of age
• C. 18-24 months of age
• D. 4-6 years of age

Correct answer: D

Rationale: The correct answer is D: 4-6 years of age. According to current CDC guidelines, a child receiving the measles, mumps, rubella (MMR) vaccine at 12 months of age should plan to receive the MMR booster between 4-6 years of age. Choices A, B, and C are incorrect as they do not align with the CDC's recommended age range for the MMR vaccine booster. It is crucial for healthcare providers to stay updated with current guidelines to ensure the timely administration of vaccines for optimal protection.

4. The nurse is caring for a client with hyperthyroidism. Which assessment finding requires immediate intervention?

• A. Heart rate of 100 beats per minute.
• B. Blood pressure of 150/90 mm Hg.
• C. Respiratory rate of 24 breaths per minute.
• D. Weight loss of 5 pounds in one week.

Correct answer: D

Rationale: Weight loss of 5 pounds in one week in a client with hyperthyroidism is concerning as it may indicate severe hypermetabolism, leading to potential complications such as cardiac arrhythmias, muscle weakness, and other metabolic disturbances. Rapid weight loss in hyperthyroidism indicates an accelerated metabolic rate and increased energy expenditure, which can be detrimental to the client's health. The other assessment findings (heart rate of 100 beats per minute, blood pressure of 150/90 mm Hg, respiratory rate of 24 breaths per minute) are commonly seen in clients with hyperthyroidism and may not necessarily require immediate intervention unless they are significantly outside the normal range or causing distress to the client.

5. A client presents at a community-based clinic with complaints of shortness of breath, headache, often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms?

• A. asbestos
• B. silica dust
• C. histoplasmosis
• D. carbon monoxide

Correct answer: D

Rationale: The correct answer is D, carbon monoxide poisoning. This client's symptoms of shortness of breath and headache are consistent with carbon monoxide exposure, which can result from using gasoline-powered equipment in poorly ventilated areas. Asbestos (choice A) is linked to respiratory issues but does not typically present with these acute symptoms. Silica dust (choice B) exposure is associated with lung damage, not the symptoms described. Histoplasmosis (choice C) is a fungal infection and would not typically manifest with the symptoms presented by the client.

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