Nursing Elites

1. A client with a history of adrenal insufficiency is admitted with acute adrenal crisis. The client complains of nausea and joint pain, vital signs show a temperature of 102°F, heart rate of 138, and blood pressure of 80/60. Which intervention should the nurse implement first?

• A. Obtain an analgesic prescription.
• B. Infuse an intravenous fluid bolus.
• C. Administer PRN oral antipyretic.
• D. Cover the client with a cooling blanket.

Correct answer: B

Rationale: In acute adrenal crisis, the priority intervention is to infuse an intravenous fluid bolus to address the hypotension (blood pressure of 80/60) and help stabilize the client's condition. Adequate fluid volume is crucial in managing adrenal insufficiency crisis. Options A, C, and D do not directly address the hypotension and fluid volume depletion that are critical in this situation. Analgesics, antipyretics, and cooling blankets may be considered later, but the immediate focus should be on fluid resuscitation.

2. A client with a 42-week gestation refuses induction. What is the most important action the nurse should take?

• A. Discuss alternative ways to support the client's birth plan.
• B. Explain the risks of induction after 42 weeks.
• C. Ask the healthcare provider to discuss the situation with the client.
• D. Discuss the characteristics of labor with oxytocin vs. natural labor.

Correct answer: A

Rationale: The most important action for the nurse in this situation is to discuss alternative ways to support the client's birth plan. By doing so, the nurse can ensure that the client feels heard, respected, and supported in their decision-making process. While explaining the risks of induction after 42 weeks (Choice B) may be important, it is secondary to supporting the client's autonomy and preferences. Asking the healthcare provider to discuss the situation with the client (Choice C) may delay crucial communication and support that the nurse can provide. Discussing the characteristics of labor with oxytocin vs. natural labor (Choice D) is not the priority when the client has refused induction, as the focus should be on respecting their decision and exploring other options for support.

3. A client with hypertension is prescribed a beta-blocker. What teaching should the nurse provide about this medication?

• A. Instruct the client to avoid high-potassium foods.
• B. Monitor the client’s heart rate and report any bradycardia.
• C. Advise the client to rise slowly from a sitting or lying position.
• D. Instruct the client to avoid sudden position changes.

Correct answer: C

Rationale: The correct answer is to advise the client to rise slowly from a sitting or lying position. Beta-blockers can cause bradycardia and hypotension, so clients should be advised to rise slowly to prevent dizziness and falls. Monitoring the client's heart rate and blood pressure regularly is essential. Instructing the client to avoid high-potassium foods (Choice A) is not directly related to beta-blockers. While monitoring the client's heart rate (Choice B) is important, advising the client to rise slowly (Choice C) is more directly related to potential side effects of beta-blockers. Instructing the client to avoid sudden position changes (Choice D) is not as specific or essential as advising them to rise slowly to prevent adverse effects.

4. A nurse is reviewing the medication list for a client with heart failure. Which medication should the nurse question?

• A. Furosemide
• B. Digoxin
• C. Ibuprofen
• D. Carvedilol

Correct answer: C

Rationale: The correct answer is C: Ibuprofen. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can cause fluid retention, which may worsen heart failure symptoms. It should be used with caution or avoided in clients with heart failure. Furosemide (choice A) is a diuretic commonly used in heart failure to reduce fluid overload. Digoxin (choice B) is a medication that helps the heart beat stronger and slower, often used in heart failure. Carvedilol (choice D) is a beta-blocker that is beneficial in heart failure management. Therefore, Ibuprofen is the medication that the nurse should question in this scenario.

5. A client with hyperparathyroidism is preparing for surgery. Which preoperative lab finding is most important to report?

• A. Elevated serum calcium.
• B. Decreased serum albumin.
• C. Elevated serum potassium.
• D. Elevated serum magnesium.

Correct answer: A

Rationale: The correct answer is A: Elevated serum calcium. In hyperparathyroidism, elevated calcium levels can lead to complications such as kidney stones, bone pain, and fractures. During surgery, high calcium levels can affect neuromuscular function, cardiac function, and blood clotting. Therefore, it is crucial to report elevated serum calcium levels preoperatively to prevent potential surgical complications. Choices B, C, and D are not directly associated with hyperparathyroidism and are less likely to impact the surgical outcome in this scenario.

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