Nursing Elites

1. Melissa Smith came to the Emergency Department in the last week before her estimated date of confinement complaining of headaches, blurred vision, and vomiting. Suspecting PIH, the nurse should best respond to Melissa's complaints with which of the following statements?

• A. "The physician will probably want to admit you for observation."?
• B. "The physician will probably order bedrest at home."?
• C. "These are really dangerous signs."?
• D. "The physician will probably prescribe some medicine for you."?

Correct answer: B

Rationale: Pregnancy-induced hypertension (PIH) is a hypertensive disorder of pregnancy that can present after 20 weeks gestation. It is characterized by symptoms like edema, hypertension, and proteinuria, which can progress to conditions like pre-eclampsia and eclampsia. The best approach for a client with advanced PIH is rest, and home provides the most suitable environment for it. Hospitalization is not typically necessary for PIH unless there are severe complications. Medication alone is not the primary intervention for PIH; management often involves monitoring, rest, and close medical supervision. Therefore, advising bedrest at home is the most appropriate response to help manage PIH symptoms and prevent further complications, such as pre-eclampsia or eclampsia. The other options, like hospitalization for observation, emphasizing the danger of the signs without providing guidance, or assuming medication as the primary solution, are not in line with the standard management approach for PIH.

2. The client has been taking divalproex (Depakote) for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test?

• A. Alanine aminotransferase (ALT)
• B. Serum glucose
• C. Serum creatinine
• D. Serum electrolytes

Correct answer: A

Rationale: The correct answer is Alanine aminotransferase (ALT). Monitoring ALT levels is crucial when a patient is taking divalproex (Depakote) due to the risk of drug-induced hepatitis. Elevated ALT levels indicate liver damage or disorders, which can be a side effect of Depakote. Serum glucose (choice B) is not the priority for monitoring in this case, as the medication does not directly affect glucose levels. Serum creatinine (choice C) is not the most relevant test to monitor for Depakote use; it primarily assesses kidney function. Serum electrolytes (choice D) are important but do not take precedence over monitoring ALT levels when a patient is on Depakote.

3. A client comes to the clinic for assessment of his physical status and guidelines for starting a weight-reduction diet. The client's weight is 216 pounds and his height is 66 inches. The nurse identifies the BMI (body mass index) as:

• A. Within normal limits, so a weight-reduction diet is unnecessary.
• B. Lower than normal, so education about nutrient-dense foods is needed.
• C. Indicating obesity because the BMI is 35.
• D. Indicating overweight status because the BMI is 27.

Correct answer: C

Rationale: Obesity is defined by a BMI of 30 or more with no co-morbid conditions. Body Mass Index (BMI) is calculated by utilizing a chart or nomogram that plots height and weight. In this case, the client's BMI is calculated as 35, indicating obesity. A BMI of 27 falls within the overweight range, not obesity (which starts at 30). Choices A and B are incorrect because a BMI of 35 indicates obesity, not normal limits or being lower than normal. Therefore, the correct answer is C, indicating obesity based on the BMI calculation.

4. Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in clients with hypothyroidism because:

• A. it is chemically stable, nonallergenic, and can be administered orally once a day.
• B. it is available in a wide range of concentrations to meet individual client requirements.
• C. it is a prodrug of T3.
• D. it has a long half-life.

Correct answer: A

Rationale: Levothyroxine (Synthroid) is the preferred medication for hypothyroidism due to its chemical stability, nonallergenic properties, and convenient once-daily oral administration. It is safe and effective with minimal side effects when appropriately dosed. Choice B is incorrect because while Levothyroxine is available in various concentrations, it is not the reason it is the drug of choice; the primary reason is its stability and nonallergenic nature. Choice C is wrong as Levothyroxine (T4) is not a prodrug of T3; it is converted to T3 in the body. Option D is inaccurate because Levothyroxine has a long half-life (around 7 days), enabling once-daily dosing, as opposed to a short half-life.

5. The nurse is caring for a client with decreased cardiac output secondary to heart failure with fluid volume overload. The effects of diminished renal perfusion will have which physiologic response?

• A. Diuresis
• B. Increased fluid retention
• C. Elevated bicarbonate level
• D. Paroxysmal idiopathic narcosis

Correct answer: B

Rationale: When there is diminished renal perfusion due to decreased cardiac output, the kidneys receive less blood flow. This leads to a decrease in urine output and an increase in fluid retention, as the kidneys are not able to effectively filter and excrete excess fluid. Elevated bicarbonate level and paroxysmal idiopathic narcosis are not typically associated with diminished renal perfusion in heart failure. Therefore, the correct answer is 'Increased fluid retention.'

Similar Questions