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. The nurse prepares to teach clients about blood glucose monitoring. When should clients always check glucose, regardless of age or type of diabetes?

• A. Before going to bed.
• B. After meals.
• C. During acute illness.
• D. Prior to exercising.

Correct answer: C

Rationale: The correct answer is C: During acute illness. Checking blood glucose during acute illness is crucial as stress can elevate glucose levels. This monitoring is essential regardless of the client's age or the type of diabetes they have. Checking before going to bed (choice A) may be important for some individuals, but it's not as universally necessary as during acute illness. Checking after meals (choice B) and prior to exercising (choice D) are important times for monitoring blood glucose, but they are not as universally applicable as during acute illness.

3. A client with hypertension is prescribed a thiazide diuretic. What dietary recommendation should the nurse make?

• A. Encourage a diet low in carbohydrates and fats.
• B. Avoid foods high in vitamin K, such as spinach and kale.
• C. Increase salt intake to prevent dehydration.
• D. Eat potassium-rich foods like bananas and oranges.

Correct answer: D

Rationale: The correct answer is D: 'Eat potassium-rich foods like bananas and oranges.' Thiazide diuretics can lead to potassium loss, so it is essential for clients to consume potassium-rich foods to maintain adequate levels. Choice A is incorrect because focusing solely on low carbohydrates and fats does not address the specific issue of potassium loss. Choice B is unrelated as vitamin K content is not a concern with thiazide diuretics. Choice C is incorrect as increasing salt intake would exacerbate hypertension and not prevent dehydration.

4. A client on long-term corticosteroid therapy for rheumatoid arthritis presents with weakness and hypotension. What is the nurse's first action?

• A. Administer a PRN dose of corticosteroids.
• B. Place the client in a supine position.
• C. Encourage oral fluid intake.
• D. Review the client's recent medication history.

Correct answer: A

Rationale: Administering a PRN dose of corticosteroids is the correct first action when a client on long-term corticosteroid therapy presents with weakness and hypotension. In this scenario, the client is likely experiencing adrenal insufficiency due to prolonged corticosteroid use. Administering corticosteroids promptly can help correct this insufficiency and improve the client's symptoms. Placing the client in a supine position may be necessary for symptomatic hypotension, but addressing the root cause with corticosteroids is more crucial initially. Encouraging oral fluid intake is important for many conditions but is not the priority in this case. Reviewing the client's recent medication history can provide valuable information but is not the first action needed to address the client's current presentation.

5. A client with diabetes mellitus is scheduled for surgery. What is the nurse's priority action when preparing this client for surgery?

• A. Ensure the client is NPO before surgery
• B. Monitor the client's blood glucose levels
• C. Administer the client's insulin as scheduled
• D. Teach the client about postoperative care

Correct answer: B

Rationale: The correct answer is B: Monitor the client's blood glucose levels. Clients with diabetes are at risk for perioperative complications related to blood glucose fluctuations. Monitoring blood glucose levels is crucial to maintaining proper management before, during, and after surgery. Option A is not the priority action as ensuring NPO status is a standard preoperative procedure for all clients. Option C could be important but is secondary to monitoring blood glucose levels. Option D is important but not the priority during the preoperative phase.

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