Nursing Elites

1. A 10-year-old client is recovering from a splenectomy following a traumatic injury. The client's laboratory results show a hemoglobin of 9 g/dL and a hematocrit of 28 percent. The best approach for the nurse to use is to:

• A. Limit milk and milk products
• B. Encourage bed rest and quiet activities
• C. Plan nursing care around lengthy rest periods
• D. Promote a diet rich in iron

Correct answer: C

Rationale: Encouraging bed rest and quiet activities is crucial for a child recovering from a splenectomy with low hemoglobin and hematocrit levels. This approach helps conserve energy, promotes healing, and allows the body to focus on rebuilding red blood cells. Limiting milk and milk products (Choice A) is not directly related to improving the child's condition. Encouraging bed rest and quiet activities (Choice B) is appropriate as it helps in conserving energy and preventing physical exertion. Promoting a diet rich in iron (Choice D) is beneficial for improving hemoglobin levels in the long term, but immediate rest and recovery take precedence in this scenario.

2. A client with Parkinson's disease is being discharged. Which statement by the client indicates a need for further teaching?

• A. I will take my medication at the same time every day.
• B. I will increase my fiber intake to prevent constipation.
• C. I will perform range of motion exercises to maintain mobility.
• D. I will stop taking my medication if I feel better.

Correct answer: D

Rationale: The correct answer is D. Patients with Parkinson's disease should not stop taking their medication if they feel better, as doing so can worsen symptoms. It is crucial for patients to continue their prescribed medication regimen as directed by their healthcare provider. Choices A, B, and C are all appropriate actions that promote the well-being of a client with Parkinson's disease. Choice A emphasizes medication adherence, which is vital for symptom management. Choice B addresses a common issue in Parkinson's patients and shows an understanding of the importance of dietary management. Choice C highlights the significance of physical activity in maintaining mobility, which is essential for overall quality of life in Parkinson's disease.

3. A nurse on a medical-surgical unit is caring for a client. Which of the following actions should the nurse take first when using the nursing process?

• A. Obtain client information
• B. Develop a plan of care
• C. Implement nursing interventions
• D. Evaluate the client's response to treatment

Correct answer: A

Rationale: The correct answer is A: Obtain client information. The first step in the nursing process is assessment, which involves gathering data about the client's condition, needs, and preferences. This information forms the foundation for developing a comprehensive plan of care. Developing a plan of care (Choice B) comes after assessment to address the identified needs. Implementing nursing interventions (Choice C) follows the development of the plan of care. Evaluating the client's response to treatment (Choice D) occurs after implementing the interventions to determine the effectiveness of the care provided. Therefore, the initial and priority step is to obtain client information through assessment.

4. A client with a history of heart failure is admitted with weight gain and peripheral edema. Which medication should the LPN/LVN anticipate being prescribed?

• A. Lisinopril (Zestril)
• B. Furosemide (Lasix)
• C. Metoprolol (Lopressor)
• D. Simvastatin (Zocor)

Correct answer: B

Rationale: Furosemide (Lasix) is the correct answer. In a client with heart failure experiencing weight gain and peripheral edema, the priority is to manage fluid overload. Furosemide is a loop diuretic commonly prescribed to reduce excess fluid in heart failure patients. Lisinopril (Zestril) is an ACE inhibitor used to treat hypertension and heart failure but does not directly address fluid overload. Metoprolol (Lopressor) is a beta-blocker that helps manage heart failure symptoms but does not primarily target fluid retention. Simvastatin (Zocor) is a statin used to lower cholesterol levels and is not indicated for managing fluid overload in heart failure.

5. A client has been tentatively diagnosed with Graves' disease (hyperthyroidism). Which of these findings noted on the initial nursing assessment requires quick intervention by the nurse?

• A. A report of 10 pounds weight loss in the last month
• B. A comment by the client 'I just can't sit still.'
• C. The appearance of eyeballs that appear to 'pop' out of the client's eye sockets
• D. A report of the sudden onset of irritability in the past 2 weeks

Correct answer: C

Rationale: The appearance of eyeballs that appear to 'pop' out of the client's eye sockets, known as exophthalmos, requires quick intervention as it is a severe symptom of Graves' disease. Exophthalmos can indicate an acute condition and may lead to serious complications such as optic nerve damage or corneal ulceration. Weight loss, restlessness, and irritability are common manifestations of hyperthyroidism but do not pose immediate risks compared to the ocular complications associated with exophthalmos.

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