Nursing Elites

1. A client with a history of deep vein thrombosis (DVT) is being treated with anticoagulants. Which of these findings is most concerning to the nurse?

• A. Presence of bruising on the arms and legs
• B. The client reports new onset of severe headache
• C. The client reports pain and swelling in the calf
• D. The client reports increased urination

Correct answer: C

Rationale: The correct answer is C because pain and swelling in the calf can indicate a new or worsening DVT, requiring immediate attention. Bruising on the arms and legs may be a common side effect of anticoagulants but is not as concerning as a potential DVT. Severe headache may indicate other conditions like a migraine or hypertension and is not directly related to DVT. Increased urination is not typically associated with DVT and may point towards other health issues like diabetes or urinary tract infections.

2. When speaking with a group of teens, which side effect of chemotherapy for cancer would the nurse expect this group to be more interested in discussing?

• A. Mouth sores
• B. Fatigue
• C. Diarrhea
• D. Hair loss

Correct answer: D

Rationale: Hair loss is the correct answer. Teens are often more concerned about hair loss because of its visible impact and social implications. While mouth sores, fatigue, and diarrhea are also common side effects of chemotherapy, hair loss tends to be a significant concern for teens due to its effect on self-image and confidence.

3. A client receiving filgrastim (Neupogen) for neutropenia is learning about compromised host precautions. The selection of which lunch suggests the client has learned about necessary dietary changes?

• A. grilled chicken sandwich and skim milk
• B. roast beef, mashed potatoes, and green beans
• C. peanut butter sandwich, banana, and iced tea
• D. barbecue beef, baked beans, and cole slaw

Correct answer: B

Rationale: Roast beef, mashed potatoes, and green beans are suitable choices for clients with neutropenia because they are considered safe options that help avoid potential sources of infection. Grilled chicken, peanut butter, and barbecue beef may carry a higher risk of bacterial contamination, which could be harmful to a client with compromised immunity.

4. The nurse has been teaching a client with Insulin Dependent Diabetes Mellitus. Which statement by the client indicates a need for further teaching?

• A. I use a sliding scale to adjust regular insulin to my sugar level.
• B. Since my eyesight is so bad, I ask the nurse to fill several syringes.
• C. I keep my regular insulin bottle in the refrigerator.
• D. I always make sure to shake the NPH bottle hard to mix it well.

Correct answer: D

Rationale: Shaking the NPH insulin bottle hard can cause air bubbles and affect dosing accuracy; it should be rolled gently instead.

5. The nurse is monitoring a client who has just had a thyroidectomy. The client complains of tingling in the fingers and around the mouth. Which of these findings should the nurse assess first?

• A. Calcium level
• B. Chvostek's sign
• C. Trousseau's sign
• D. Serum potassium level

Correct answer: B

Rationale: The correct answer is B, Chvostek's sign. This is a classic sign of hypocalcemia, which can occur after a thyroidectomy due to injury or removal of the parathyroid glands. Hypocalcemia can lead to serious complications like tetany and laryngospasm, necessitating immediate attention. Assessing Chvostek's sign helps in early identification and management of hypocalcemia. Choices A, C, and D are not the priority in this situation. While assessing the calcium level is important for diagnosing hypocalcemia, the immediate concern is to identify clinical signs like Chvostek's sign, which indicate acute hypocalcemia. Trousseau's sign is also related to hypocalcemia but is not the most critical sign to assess first. Serum potassium level, although important for overall electrolyte balance, is not directly related to the client's current symptoms of tingling in the fingers and around the mouth.

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