Nursing Elites

1. Paula is a 32-year-old woman seeking evaluation and treatment for major depressive symptoms. A major nursing priority during the assessment process includes which of the following?

• A. meaning of current stressors
• B. possibility of self-harm
• C. motivation to participate in treatment
• D. presence of alcohol or other drug use

Correct answer: B

Rationale: The correct answer is to consider the possibility of self-harm during the assessment process. This is crucial because unless the client is first assessed for self-harm or suicide potential, the necessary degree of vigilance in the client's environment may not be observed. While understanding the meaning of current stressors is important for treatment planning, ensuring the client's safety takes precedence. Motivation to participate in treatment and the presence of alcohol or other drug use are also important aspects to assess but ensuring the client's safety is the top priority in this scenario.

2. Post thyroidectomy the nurse assesses for complications by performing which of the following assessments?

• A. Accu-Chek
• B. Chvostek's
• C. Ballottement
• D. Ice water colonic

Correct answer: B

Rationale: The correct answer is Chvostek's. A positive Chvostek's and Trousseau's sign is indicative of tetany, which is associated with low calcium levels. This can occur if parathyroid glands are accidentally removed during thyroidectomy. Accu-Chek is a brand of blood glucose monitor used for checking blood sugar levels and is not relevant in this context. Ballottement is a technique used in physical examination to assess for fluid in the body, typically in the abdomen or joints. Ice water colonic is not a standard medical assessment and is not relevant to post-thyroidectomy complications.

3. Which of the following is the drug of choice to decrease uric acid levels?

• A. prednisone (Colisone)
• B. allopurinol (Zyloprim)
• C. indomethacin (Indocin)
• D. hydrochlorothiazide (HydroDiuril)

Correct answer: B

Rationale: Allopurinol is the correct drug to decrease uric acid levels as it is used to treat gout by reducing uric acid formation. Prednisone is a corticosteroid that decreases inflammation, not uric acid levels. Indomethacin is an analgesic, anti-inflammatory, and antipyretic agent, not specifically used to reduce uric acid levels. Hydrochlorothiazide is a thiazide diuretic primarily used for treating hypertension and edema, not for reducing uric acid levels.

4. Which instruction should be given in a health education class regarding testicular cancer?

• A. All males should perform a testicular exam after a warm bath or shower.
• B. Testicular exams should be performed on a daily basis.
• C. Reddening or darkening of the scrotum is a normal finding.
• D. Testicular exams should be performed after a warm bath or shower.

Correct answer: D

Rationale: The correct instruction for testicular cancer education is that testicular exams should be performed after a warm bath or shower as it relaxes the scrotum and makes the exam easier. Testicular exams should be done monthly by all men starting around age 15, not after the age of 30 (Choice A) or on a daily basis (Choice B), which is unnecessary and may lead to unnecessary anxiety. Reddening or darkening of the scrotum is not a normal finding (Choice C) and should be reported to a healthcare provider for further evaluation.

5. A 93-year-old female with a history of Alzheimer's Disease gets admitted to an Alzheimer's unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?

• A. Recommend the patient remain in her room at all times.
• B. Recommend family members bring pictures to the patient's room.
• C. Recommend a speech therapy consult to the doctor.
• D. Recommend the patient attempt to walk pushing the w/c for safety.

Correct answer: B

Rationale: For a 93-year-old female with Alzheimer's Disease exhibiting signs of increased confusion and limited stability with gait, recommending family members to bring pictures to the patient's room is the most appropriate course of action. Visual stimulation in the form of pictures may help decrease signs of confusion and provide comfort to the patient. Option A is incorrect as isolating the patient in her room at all times may worsen her condition by further limiting stimulation and interaction. Option C is incorrect as speech therapy may not directly address the current issues of confusion and gait instability. Option D is incorrect as pushing a wheelchair may not be safe for the patient if she is refusing to use it, potentially leading to falls or further distress.

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