Nursing Elites

1. A client who had a subtotal parathyroidectomy two days ago is now preparing for discharge. Which assessment finding requires immediate provider notification?

• A. Afebrile with a normal pulse.
• B. No bowel movement since surgery.
• C. No appetite for breakfast.
• D. A positive Chvostek's sign.

Correct answer: D

Rationale: A positive Chvostek's sign suggests hypocalcemia, which is a post-parathyroidectomy complication and requires prompt treatment. The other options are less urgent: being afebrile with a normal pulse is expected, no bowel movement since surgery can be managed with interventions like early ambulation and stool softeners, and no appetite for breakfast is common postoperatively and can be addressed without immediate provider notification.

2. A client with multiple sclerosis is receiving intravenous methylprednisolone. What is the nurse's priority action?

• A. Monitor blood glucose levels every 6 hours.
• B. Monitor for signs of infection.
• C. Encourage increased oral fluid intake.
• D. Check the client's temperature every 4 hours.

Correct answer: B

Rationale: When a client with multiple sclerosis is receiving intravenous methylprednisolone, the nurse's priority action is to monitor for signs of infection. Corticosteroids like methylprednisolone can suppress the immune system, increasing the risk of infection. Monitoring for signs of infection allows for early detection and prompt intervention. Monitoring blood glucose levels may be important in clients receiving corticosteroids for prolonged periods, but it is not the priority in this case. Encouraging increased oral fluid intake is generally beneficial but not the priority over monitoring for infection. Checking the client's temperature is important but not the priority action compared to monitoring for signs of infection.

3. The nurse is providing education to a client who experiences recurrent levels of moderate anxiety in response to situations and perceived stress. In addition to information about prescribed medication and administration, which instruction should the nurse include in the teaching?

• A. Practice using muscle relaxation techniques
• B. Take medication only when anxiety is at its worst
• C. Avoid interactions that trigger stress
• D. Engage in exercise during anxious periods

Correct answer: A

Rationale: Teaching relaxation techniques, such as muscle relaxation, helps the client manage anxiety more effectively. These techniques can be practiced regularly to reduce overall anxiety and can complement prescribed medications. Choice B is incorrect because medication should be taken as prescribed, not only when anxiety is at its worst. Choice C is incorrect as avoiding interactions that trigger stress may not always be feasible and does not teach the client coping mechanisms. Choice D is incorrect as engaging in exercise during anxious periods may not be the most effective strategy for managing moderate anxiety levels.

4. An older adult client with gastroenteritis has been taking the antidiarrheal diphenoxylate for the past 24 hours. What finding requires the nurse to take further action?

• A. Monitor the client’s fluid intake.
• B. Obtain a stool sample for testing.
• C. Administer a laxative to clear the infection.
• D. Assess skin turgor and provide fluids.

Correct answer: D

Rationale: The correct answer is D. Assessing skin turgor is crucial as tented skin turgor indicates dehydration, which can be worsened by antidiarrheal medications like diphenoxylate. Providing fluids is essential to address dehydration in this client. Monitoring fluid intake (choice A) is important, but assessing skin turgor takes precedence in this situation. Obtaining a stool sample for testing (choice B) could be necessary for diagnostic purposes but is not the immediate priority. Administering a laxative (choice C) is contraindicated in this case as it can worsen the client's condition by further exacerbating fluid loss.

5. Which statement made by the client indicates an understanding of the instructions regarding the administration of alendronate (Fosamax)?

• A. I will take the medication at bedtime to avoid stomach upset.
• B. I will take the medication with a full glass of water first thing in the morning.
• C. I will lie down for 30 minutes after taking the medication.
• D. I will take the medication with food to reduce stomach irritation.

Correct answer: B

Rationale: The correct answer is B. Alendronate (Fosamax) should be taken with a full glass of water in the morning to prevent esophageal irritation and ensure proper absorption. Choice A is incorrect because taking alendronate at bedtime increases the risk of esophageal irritation due to lying down. Choice C is incorrect because patients should remain upright for at least 30 minutes after taking alendronate to prevent esophageal irritation. Choice D is incorrect because alendronate should be taken on an empty stomach, not with food, to enhance absorption.

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