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 a history of asthma reports using an albuterol inhaler more frequently than prescribed. Which action should the nurse take first?

• A. Notify the healthcare provider immediately
• B. Schedule a pulmonary function test
• C. Assess the client's respiratory status
• D. Instruct the client to decrease inhaler use

Correct answer: C

Rationale: Increased use of a rescue inhaler like albuterol may indicate worsening asthma symptoms. The nurse should first assess the client's respiratory status to determine the severity of the issue and the next steps in care. Option A is not the first action because assessing the client's condition should precede notifying the healthcare provider. Option B, scheduling a pulmonary function test, is not the priority as immediate assessment of the client's respiratory status is crucial. Instructing the client to decrease inhaler use should come after assessing the client's condition to ensure the appropriate intervention.

3. A client with cirrhosis is at risk for bleeding due to impaired liver function. Which laboratory result is the most important to monitor?

• A. Blood urea nitrogen (BUN)
• B. Prothrombin time (PT)
• C. Aspartate aminotransferase (AST)
• D. Serum albumin

Correct answer: B

Rationale: Prothrombin time (PT) measures the time it takes for blood to clot and is a critical indicator of bleeding risk in clients with liver dysfunction. Impaired liver function reduces clotting factor production, leading to an increased PT, which requires close monitoring. Monitoring BUN (Choice A) is more indicative of kidney function, not clotting ability. Aspartate aminotransferase (AST) (Choice C) and serum albumin (Choice D) are important indicators of liver function, but they do not directly assess the client's bleeding risk.

4. While palpating the gallbladder of a mildly obese client, what finding does the nurse expect if the gallbladder is inflamed?

• A. Severe tenderness and guarding
• B. Slight discomfort upon palpation
• C. A sensation of fullness
• D. No symptoms unless the gallbladder is extremely inflamed

Correct answer: A

Rationale: Correct. If the gallbladder is inflamed, the nurse would expect to find severe tenderness and guarding, which are typical signs of acute cholecystitis. This indicates an inflammatory process in the gallbladder. Choices B, C, and D are incorrect because slight discomfort, a sensation of fullness, or no symptoms unless extremely inflamed are not typical findings associated with gallbladder inflammation.

5. An older adult client with chronic emphysema is admitted with acute onset of weakness, palpitation, and vomiting. Which information is most important for the nurse to obtain during the initial interview?

• A. Medication compliance over the past few weeks.
• B. Recent sleep patterns and rest.
• C. Recent history of smoking.
• D. Activity level prior to symptom onset.

Correct answer: A

Rationale: The correct answer is A: Medication compliance over the past few weeks. In a client with chronic emphysema experiencing acute symptoms, it is crucial to assess medication compliance as it directly impacts symptom control and disease management. Ensuring the client has been adherent to their prescribed medications can provide insights into potential exacerbating factors or the need for adjustments in the treatment plan. Choices B, C, and D are less critical during the initial assessment compared to medication compliance. Recent sleep patterns and rest (choice B) may be relevant but are secondary to ensuring proper medication management. While smoking history (choice C) is important in chronic lung conditions, the immediate focus should be on the current status of medication use. Activity level prior to symptom onset (choice D) is also pertinent but not as crucial as confirming medication compliance to address the acute symptoms.

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