Nursing Elites

1. A client diagnosed with major depressive disorder refuses to get out of bed, eat, or participate in group therapy. Which intervention is most important for the nurse to implement?

• A. Offer the client high-calorie snacks and frequent small meals.
• B. Ask the client why they are not participating in therapy.
• C. Sit with the client and offer support without demanding participation.
• D. Encourage the client to discuss their feelings of hopelessness.

Correct answer: C

Rationale: In cases of major depressive disorder where the client is non-participatory and withdrawn, sitting with the client and providing support without pressuring them to engage in activities like eating or therapy is crucial. This approach respects the client's current state, builds trust, and creates a supportive environment that can eventually lead to the client opening up and accepting help.

2. A patient with type 2 diabetes is prescribed metformin. What instruction should the nurse provide regarding this medication?

• A. Take the medication on an empty stomach.
• B. Monitor for signs of hypoglycemia.
• C. Take the medication with meals.
• D. Increase intake of simple carbohydrates.

Correct answer: C

Rationale: The correct instruction for a patient prescribed metformin is to take the medication with meals. This helps reduce gastrointestinal side effects commonly associated with metformin. Patients should also be educated about the signs of lactic acidosis, a rare but serious side effect associated with metformin use.

3. What is the most appropriate nursing intervention to help alleviate severe abdominal pain in a patient with acute pancreatitis?

• A. Encourage oral intake of clear fluids with electrolytes.
• B. Place the patient in a semi-Fowler's position.
• C. Administer prescribed opioid analgesics.
• D. Apply a cold pack to the abdomen.

Correct answer: C

Rationale: Administering prescribed opioid analgesics is the most appropriate nursing intervention to alleviate severe abdominal pain in a patient with acute pancreatitis. Opioid analgesics help manage severe pain effectively in such cases. Encouraging oral intake of clear fluids with electrolytes is contraindicated due to the need for pancreatic rest and potential exacerbation of symptoms. Placing the patient in a semi-Fowler's position helps reduce pressure on the abdomen, unlike a supine position that can worsen the pain. Applying a cold pack is not recommended as it can potentially increase discomfort and vasoconstriction in acute pancreatitis.

4. The nurse is administering sevelamer (RenaGel) during lunch to a client with end-stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals?

• A. Prevents indigestion associated with the ingestion of spicy foods.
• B. Binds with phosphorus in foods and prevents absorption.
• C. Promotes stomach emptying and prevents gastric reflux.
• D. Buffers hydrochloric acid and prevents gastric erosion.

Correct answer: B

Rationale: Sevelamer (RenaGel) binds with phosphorus in foods and prevents its absorption. By taking RenaGel with meals, the binding of phosphorus helps to reduce the phosphorus load absorbed from food, thus aiding in the management of hyperphosphatemia in clients with ESRD.

5. Which problem in a client requires the most immediate intervention by the nurse?

• A. Finger paresthesias related to carpal tunnel syndrome.
• B. Increasing sharp pain related to compartment syndrome.
• C. Increasing burning pain related to a Morton's neuroma.
• D. Increasing sharp pain related to plantar fasciitis.

Correct answer: B

Rationale: The correct answer is B: Increasing sharp pain related to compartment syndrome. Compartment syndrome is a serious condition where increased pressure within a muscle compartment compromises circulation and can lead to tissue damage. Immediate intervention is crucial to prevent permanent damage to muscles and nerves, including tissue necrosis and nerve injury. Choices A, C, and D do not present the same level of urgency as compartment syndrome, making them less critical for immediate intervention. Carpal tunnel syndrome, Morton's neuroma, and plantar fasciitis may cause discomfort and functional limitations but are not typically considered emergencies requiring urgent intervention like compartment syndrome.

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