Nursing Elites

1. A client with a history of chronic kidney disease presents with increased swelling and shortness of breath. What is the nurse's priority action?

• A. Administer oxygen at 2 liters per nasal cannula.
• B. Administer a diuretic as prescribed.
• C. Monitor the client's vital signs.
• D. Reposition the client to improve lung expansion.

Correct answer: B

Rationale: The correct answer is to administer a diuretic as prescribed. In a client with chronic kidney disease experiencing increased swelling and shortness of breath, the priority action is to address fluid retention. Administering a diuretic helps reduce fluid overload, alleviate symptoms, and prevent complications associated with fluid buildup. Option A is not the priority in this situation as addressing fluid retention takes precedence over providing oxygen. While monitoring vital signs is important, it is secondary to addressing the underlying cause of symptoms. Repositioning the client may help with comfort but does not directly address the fluid overload seen in chronic kidney disease.

2. An 11-year-old client admitted to the mental health unit after threatening self-harm. What is the best activity to establish rapport and promote coping?

• A. Bring the client to the team meeting to discuss the treatment plan.
• B. Play a board game with the client and start discussing stressors.
• C. Explain the purpose of each medication the client is taking.
• D. Ask the client to write feelings in a journal and review together.

Correct answer: B

Rationale: Playing a board game with the client is an effective way to establish rapport in a relaxed setting, allowing the client to open up about stressors. This activity promotes coping by creating a safe and engaging environment for the client to express their feelings. Choices A, C, and D may not be suitable initially as they involve more formal or intrusive approaches that may not be suitable for building rapport with a client experiencing emotional distress.

3. A male client with heart failure becomes short of breath, anxious, and has pink frothy sputum. What is the first action the nurse should take?

• A. Consult the charge nurse about administering morphine.
• B. Administer the morphine sulfate as prescribed.
• C. Withhold the morphine until the dyspnea resolves.
• D. Review the need for the morphine prescription with the provider.

Correct answer: B

Rationale: The correct answer is B: Administer the morphine sulfate as prescribed. In this situation, the client is experiencing symptoms of acute pulmonary edema, a complication of heart failure. Morphine is indicated as it helps reduce anxiety and respiratory distress by decreasing preload and afterload. It dilates blood vessels, reducing the workload of the heart and improving oxygenation. The priority is to administer the morphine promptly to alleviate the client's distress and improve oxygenation. Consulting the charge nurse (A) or reviewing the need for the morphine prescription with the provider (D) would cause a delay in providing essential treatment. Withholding the morphine (C) would not be appropriate as it is indicated for this condition.

4. A 48-year-old client with chronic alcoholism is admitted to the hospital. The nurse would anticipate that the client may be deficient in which vitamins?

• A. Vitamin B and vitamin C
• B. Vitamin D and vitamin E
• C. Vitamin K and vitamin A
• D. Vitamin A and vitamin E

Correct answer: A

Rationale: The correct answer is A. Chronic alcoholism commonly leads to deficiencies in B vitamins, particularly thiamine, and vitamin C. Thiamine deficiency can result in serious neurological issues like Wernicke-Korsakoff syndrome, while vitamin C deficiency can lead to scurvy. Choices B, C, and D are incorrect because vitamin D and E deficiencies are not typically associated with chronic alcoholism.

5. A client who recently received a prescription for ramelteon to treat sleep deprivation reports experiencing several side effects since taking the drug. Which side effect should the nurse report to the healthcare provider?

• A. Somnambulism
• B. Dry mouth
• C. Vivid dreams
• D. Daytime sleepiness

Correct answer: A

Rationale: The correct answer is A, 'Somnambulism' (sleepwalking). Somnambulism is a potentially dangerous side effect that should be reported to the healthcare provider immediately. Sleepwalking can pose risks to the individual's safety and may indicate a serious adverse reaction to the medication. Dry mouth (choice B), vivid dreams (choice C), and daytime sleepiness (choice D) are common side effects of ramelteon and are generally not considered as urgent or serious as somnambulism. While these side effects can impact the client's quality of life, they are not typically associated with immediate safety concerns.

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