Nursing Elites

1. A client with a history of chronic heart failure is admitted with shortness of breath. Which laboratory value should be closely monitored?

• A. Serum sodium level
• B. Serum potassium level
• C. Serum creatinine level
• D. Hemoglobin level

Correct answer: B

Rationale: Corrected Rationale: In a client with chronic heart failure, serum potassium levels should be closely monitored to assess for hyperkalemia, which can worsen heart failure. Monitoring serum sodium levels is not the priority in this case. Serum creatinine level monitoring is more related to kidney function than heart failure. Hemoglobin levels are important but not the primary concern when assessing heart failure exacerbation.

2. A 10-year-old who has terminal brain cancer asks the nurse, 'What will happen to my body when I die?' How should the nurse respond?

• A. Your mother and father will be here soon. Talk to them about that.'
• B. Why do you want to know about what will happen to your body when you die?'
• C. The heart will stop beating and you will stop breathing.'
• D. Are you concerned about where your spirit will go?'

Correct answer: C

Rationale: The correct response when a terminally ill child asks about what will happen to their body when they die is to provide a truthful and straightforward answer. Choice C, 'The heart will stop beating and you will stop breathing,' is the best response because it offers a simple and honest explanation without delving into spiritual or emotional aspects that may be confusing or distressing to the child. Choices A and D deflect the question and do not address the child's inquiry directly. Choice B, 'Why do you want to know about what will happen to your body when you die?' may come across as dismissive or evasive, rather than providing the clear information the child is seeking.

3. A client with chronic heart failure is admitted with shortness of breath and a new onset of confusion. Which intervention should the nurse implement first?

• A. Obtain a neurological assessment.
• B. Administer oxygen therapy.
• C. Monitor the client's urine output.
• D. Obtain an electrocardiogram (ECG).

Correct answer: A

Rationale: The correct answer is to obtain a neurological assessment. In a client with chronic heart failure presenting with confusion, the priority is to assess neurological status to rule out potential causes such as hypoxia or other complications. Administering oxygen therapy (Choice B) is important but assessing the neurological status takes precedence in this scenario. Monitoring urine output (Choice C) and obtaining an ECG (Choice D) may be necessary but are not the initial priority when a client presents with confusion alongside shortness of breath.

4. A woman who takes pyridostigmine for myasthenia gravis (MG) arrives at the emergency department complaining of extreme muscle weakness. Her adult daughter tells the nurse that since yesterday her mother has been unable to smile. Which assessment finding warrants immediate intervention by the nurse?

• A. Uncontrollable drooling.
• B. Inability to raise voice.
• C. Tingling of extremities.
• D. Eyelid drooping.

Correct answer: A

Rationale: Uncontrollable drooling can be a sign of a myasthenic crisis, which requires immediate medical intervention to prevent respiratory failure. Drooling indicates difficulty in swallowing, which can lead to aspiration and respiratory compromise. Inability to raise voice (choice B) and tingling of extremities (choice C) are not typically associated with myasthenic crisis. Although eyelid drooping (choice D) is a common symptom of myasthenia gravis, it is not as urgent as uncontrollable drooling in indicating a potential crisis.

5. The practical nurse (PN) is assigned to work with three registered nurses (RNs) who are caring for neurologically compromised clients. The client with which change in status is best to assign to the PN?

• A. Diabetic ketoacidosis with a Glasgow Coma Scale score change from 10 to 7.
• B. Myxedema coma with a blood pressure change from 80/50 to 70/40.
• C. Viral meningitis with a temperature change from 101°F to 102°F.
• D. Subdural hematoma with a blood pressure change from 150/80 to 170/60.

Correct answer: C

Rationale: The client with viral meningitis and a temperature change is the most stable and appropriate for assignment to the PN. A change in temperature from 101°F to 102°F is not as critical as changes in Glasgow Coma Scale score, blood pressure, or wider blood pressure variations. The other clients require more complex monitoring and intervention due to their critical changes in status.

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