Nursing Elites

1. While caring for a client with bilateral chest tubes, the bubbling in the water-seal chamber of the right chest tube stops. What action is most important for the nurse to take?

• A. Check the chest tube connections to the water-seal container
• B. Replace the water-seal collection container
• C. Increase the amount of wall suction connected to the right chest tube
• D. Milk the tubing connected to the right chest tube

Correct answer: A

Rationale: The most important action for the nurse to take when the bubbling in the water-seal chamber of the right chest tube stops is to check the chest tube connections to the water-seal container. This is crucial to ensure there are no disconnections or leaks affecting the bubbling. Replacing the water-seal collection container (choice B) is not necessary unless there is a malfunction; increasing suction (choice C) without assessing the connections can be harmful, and 'milking' the tubing (choice D) is an inappropriate action that can cause damage to the system.

2. The nurse is demonstrating wound care to a client following abdominal surgery. In what order should the nurse teach the technique?

• A. Remove old dressing using clean gloves. Discard gloves with old dressing
• B. Moisten sterile gauze with normal saline. Clean wound from least contaminated area to most contaminated area
• C. Apply sterile gauze dressing to wound area
• D. Secure dressing with tape

Correct answer: A

Rationale: The correct order ensures proper aseptic technique and wound care to prevent infection. The first step is to remove the old dressing using clean gloves to prevent contamination. Discarding the gloves with the old dressing helps maintain cleanliness. Choices B, C, and D are incorrect because cleaning the wound, applying a new dressing, and securing it should come after removing the old dressing to maintain asepsis and prevent infection.

3. An older male client is admitted to the mental health unit with a sudden onset of global disorientation and is continuously conversing with his mother, who died 50 years ago. The nurse reviews the multiple prescriptions the client is currently taking and assesses his urine specimen, which is cloudy, dark yellow, and has a foul odor. These findings suggest that this client is experiencing which condition?

• A. Psychotic episode
• B. Dementia
• C. Delirium
• D. Depression

Correct answer: C

Rationale: The correct answer is C, delirium. The sudden onset of global disorientation along with cloudy, dark yellow urine with a foul odor are indicative of delirium. Delirium is an acute condition characterized by a fluctuating disturbance in awareness and cognition. In this case, the symptoms are suggestive of an underlying physiological cause, such as infection or medication side effects. Choice A, psychotic episode, is less likely as the symptoms are more in line with delirium than a primary psychotic disorder. Choice B, dementia, is a chronic and progressive condition, not typically presenting with sudden onset disorientation. Choice D, depression, does not align with the acute cognitive changes and urine abnormalities described in the scenario.

4. A female client tells the clinic nurse that she has doubts about binge eating but cannot make herself vomit after meals. Which action by the nurse provides data to support the suspected diagnosis of bulimia?

• A. Ask the client to complete a food diary for the last 3 days
• B. Review the client’s lab data to determine her TSH, T3, and T4 levels
• C. Interview the client about her use of laxatives and diuretics
• D. Encourage the client to describe her daily exercise regimen

Correct answer: C

Rationale: Inquiring about laxative and diuretic use helps confirm bulimia as these are common behaviors associated with the disorder. Asking the client to complete a food diary (Choice A) may provide information on eating patterns but does not directly support the diagnosis of bulimia. Reviewing lab data (Choice B) for thyroid function is not specific to bulimia. Encouraging the client to describe her exercise regimen (Choice D) may be relevant for overall health assessment but does not specifically address bulimia symptoms.

5. The nurse notes that a depressed female client has been more withdrawn and non-communicative during the past two weeks. Which intervention is most important to include in the updated plan of care for this client?

• A. Encourage the client's family to visit more often
• B. Schedule a daily conference with the social worker
• C. Encourage the client to participate in group activities
• D. Engage the client in a non-threatening conversation

Correct answer: D

Rationale: Engaging the client in a non-threatening conversation is crucial as it can help build trust and provide support, addressing the client's withdrawal. This intervention focuses on establishing a therapeutic relationship and giving the client an opportunity to express their feelings. Choices A, B, and C do not directly target the client's need for communication and may not address the underlying issues contributing to her withdrawal. Encouraging the client's family to visit more often (Choice A) may add pressure or discomfort to the client. Scheduling a daily conference with the social worker (Choice B) may not address the client's immediate need for communication. Encouraging the client to participate in group activities (Choice C) may be overwhelming for the client and not address her withdrawal directly.

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