Nursing Elites

1. During an inspection of a client's fingernails, the nurse notices a suspected abnormality in the shape and character of the nails. Which finding should the nurse document?

• A. Clubbed nails
• B. Splinter hemorrhages
• C. Longitudinal ridges
• D. Koilonychia or spoon nails

Correct answer: A

Rationale: Clubbed nails are a significant finding in clients with chronic hypoxia or lung disease. This abnormality is characterized by an increased curvature of the nails and softening of the nail bed. It can indicate underlying health conditions such as respiratory or cardiovascular issues. Splinter hemorrhages (B) are small areas of bleeding under the nails, typically associated with infective endocarditis. Longitudinal ridges (C) are often a normal age-related change in the nails. Koilonychia or spoon nails (D) present as a concave shape of the nails and are commonly seen in clients with iron deficiency anemia or hemochromatosis. Therefore, documenting clubbed nails is the most relevant abnormality to report and investigate further.

2. Which information should the nurse collect during the admission assessment of a terminally ill client to an acute care facility?

• A. Name of funeral home to contact
• B. Client's wishes regarding organ donation
• C. Contact information for the client's next of kin
• D. Healthcare proxy information

Correct answer: B

Rationale: During the admission assessment of a terminally ill client, it is crucial for the nurse to collect the client's wishes regarding organ donation. This information is vital to ensure that the care provided aligns with the client's values and preferences. Option A, 'Name of funeral home to contact,' is not a priority during the admission assessment and can be addressed later. Option C, 'Contact information for the client's next of kin,' is important but not as critical as understanding the client's wishes regarding organ donation. Option D, 'Healthcare proxy information,' is important for decision-making if the client is unable to make healthcare decisions, but knowing the client's wishes regarding organ donation takes precedence in this scenario.

3. A client is complaining of a tingling sensation in the fingers, nose tip, and earlobes 24 hours after a total thyroidectomy. Which measure should the PN implement first?

• A. Apply sequential compression devices bilaterally
• B. Initiate prescribed L-thyroxine replacement therapy
• C. Obtain prescribed calcium gluconate for tetany
• D. Prepare for emergency tracheotomy at the bedside

Correct answer: C

Rationale: The correct answer is C: Obtain prescribed calcium gluconate for tetany. Tingling sensations post-thyroidectomy may indicate hypocalcemia, a potential complication that requires prompt treatment with calcium gluconate to prevent tetany. Initiating L-thyroxine replacement therapy (choice B) is important but not the first priority in this situation. Applying sequential compression devices (choice A) is not indicated for tingling sensations and does not address the potential complication of hypocalcemia. Preparing for an emergency tracheotomy (choice D) is not warranted based on the client's symptoms of tingling sensations.

4. When assisting an older male client recovering from a stroke to ambulate with a cane, where should the nurse place the cane in relation to the client's body?

• A. In front of the body to lean on while stepping forward
• B. On the opposite side of the affected extremity
• C. Approximately one foot away from the body to stabilize balance
• D. On the same side as the affected extremity

Correct answer: B

Rationale: The correct answer is B: 'On the opposite side of the affected extremity.' Placing the cane on the opposite side of the affected extremity provides maximum support and stability during ambulation for a client recovering from a stroke. This positioning helps to offload weight from the affected side and improves balance. Choice A is incorrect because placing the cane in front of the body can lead to incorrect weight distribution and instability. Choice C is incorrect as placing the cane one foot away from the body may not provide adequate support and can compromise balance. Choice D is incorrect as placing the cane on the same side as the affected extremity does not offer the necessary balance and support needed for safe ambulation.

5. A client who is at full-term gestation is in active labor and complains of a cramp in her leg. Which intervention should the nurse implement?

• A. Massage the calf and foot
• B. Elevate the leg above the heart
• C. Check the pedal pulse in the affected leg
• D. Extend the leg and flex the foot

Correct answer: D

Rationale: The correct intervention for a client in active labor complaining of a leg cramp is to extend the leg and flex the foot. This action helps stretch the muscles that are cramping, providing relief. Massaging the calf and foot (Choice A) may not be as effective for relieving the cramp. Elevating the leg above the heart (Choice B) is not indicated for a leg cramp. Checking the pedal pulse in the affected leg (Choice C) is unrelated to addressing the leg cramp.

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