Nursing Elites

1. A client has had several episodes of clear, watery diarrhea that started yesterday. What action should the nurse implement?

• A. Administer a prescribed PRN antiemetic
• B. Assess the client for the presence of hemorrhoids
• C. Check the client’s hemoglobin level
• D. Review the client’s current list of medications

Correct answer: D

Rationale: The correct action for the nurse to implement in a client experiencing clear, watery diarrhea is to review the client's current list of medications. Certain medications can cause diarrhea as a side effect, so identifying any potential culprits is essential. Administering an antiemetic (Choice A) is not appropriate for diarrhea, as antiemetics are used to control nausea and vomiting, not diarrhea. Assessing for hemorrhoids (Choice B) is not the priority when the client is experiencing watery diarrhea; addressing the root cause is crucial. Checking the client’s hemoglobin level (Choice C) is not the immediate action needed for this situation as it does not directly address the cause of diarrhea.

2. An angry client screams at the emergency department triage nurse, “I’ve been waiting here for two hours! You and the staff are incompetent”. What is the best response for the nurse to make?

• A. The emergency department is very busy at this time.
• B. I’ll let you see the doctor next because you’ve waited so long.
• C. I’m doing the best I can for the sickest clients first.
• D. I understand you are frustrated with the wait time.

Correct answer: D

Rationale: Correct Answer: The best response for the nurse is to choose option D, 'I understand you are frustrated with the wait time.' This response demonstrates empathy and validates the client's feelings, helping to defuse the situation. Choice A is not the best response as it does not directly address the client's emotions or concerns. Choice B is inappropriate as it gives preferential treatment based on the client's behavior. Choice C, while true, does not acknowledge the client's frustration or offer empathy.

3. The nurse is assessing a first-day postpartum client. Which finding is most indicative of a postpartum infection?

• A. Oral temperature of 100.2°F (37.9°C)
• B. Blood pressure of 122/74 mmHg
• C. Moderate amount of foul-smelling lochia
• D. White blood count of 19,000/mm³ (19x10^9/L SI units)

Correct answer: C

Rationale: A foul-smelling lochia is indicative of a postpartum infection, such as endometritis. Foul-smelling lochia suggests the presence of infection due to the breakdown of tissue by bacteria, leading to the malodor. An oral temperature elevation and an elevated white blood cell count are nonspecific and can be present in various conditions other than postpartum infections, making them less indicative. A blood pressure within normal limits is not typically associated with postpartum infections.

4. When attempting to establish risk reduction strategies in a community, the nurse notes that regional studies indicate a high number of persons with growth stunting and irreversible mental deficiencies caused by hypothyroidism (cretinism). The nurse should seek funding to implement which screening measure?

• A. T3 levels in school-aged children
• B. T4 levels in newborns
• C. TSH levels in women over 45
• D. Iodine levels in all persons over 60

Correct answer: B

Rationale: Screening T4 levels in newborns is crucial as it helps in the early detection of hypothyroidism, which can prevent conditions like cretinism. Checking T3 levels in school-aged children (Choice A) is not the most appropriate measure for early detection of hypothyroidism in newborns. Monitoring TSH levels in women over 45 (Choice C) is not directly related to detecting hypothyroidism in newborns. Additionally, monitoring iodine levels in all persons over 60 (Choice D) is not specifically aimed at early detection of hypothyroidism in newborns, which is crucial to prevent cretinism.

5. When preparing to discharge a male client who has been hospitalized for an adrenal crisis, the client expresses concern about having another crisis. He tells the nurse that he wants to stay in the hospital a few more days. Which intervention should the nurse implement?

• A. Administer antianxiety medication before providing discharge instructions
• B. Schedule a follow-up appointment for an outpatient psychosocial assessment
• C. Obtain a blood cortisol level before discharge
• D. Encourage the client to remain in the hospital for a few more days

Correct answer: B

Rationale: The correct intervention is to schedule a follow-up appointment for an outpatient psychosocial assessment. This option addresses the client's concerns and provides support for managing stress and preventing future crises, which is crucial for the client's long-term care. Administering antianxiety medication before providing discharge instructions (Choice A) may not effectively address the underlying concerns. Obtaining a blood cortisol level before discharge (Choice C) is important but not the priority in this situation. Encouraging the client to remain in the hospital for a few more days (Choice D) is not the best course of action as it may not address the client's anxiety and could potentially lead to other issues.

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