Nursing Elites

1. A client with a history of heart failure is admitted with a diagnosis of pulmonary edema. Which intervention should the LPN/LVN expect to assist with first?

• A. Administer a diuretic as prescribed.
• B. Place the client in a high Fowler's position.
• C. Prepare the client for intubation.
• D. Insert an indwelling urinary catheter.

Correct answer: B

Rationale: In a client with pulmonary edema, placing them in a high Fowler's position is the priority intervention. This position helps to improve ventilation and oxygenation by decreasing venous return, reducing the workload on the heart, and facilitating fluid redistribution from the lungs. It is crucial to optimize respiratory function and oxygenation before considering other interventions like administering medications, preparing for intubation, or inserting a urinary catheter. Administering a diuretic, preparing for intubation, or inserting a urinary catheter may be necessary but should follow the priority of improving oxygenation through positioning.

2. An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that this client's tongue is somewhat cracked, and his eyeballs appear sunken into his head. Which nursing intervention is indicated?

• A. Help the client determine ways to increase his fluid intake.
• B. Obtain an appointment for the client to have an eye examination.
• C. Instruct the client to use oxygen at night and increase humidification.
• D. Schedule the client for tests to determine his sensitivity to cat hair.

Correct answer: A

Rationale: The client's cracked tongue and sunken eyes indicate dehydration. Therefore, the priority nursing intervention is to help the client determine ways to increase his fluid intake. Dehydration can exacerbate the client's emphysema symptoms and lead to further complications. Monitoring and addressing the client's fluid intake is crucial for maintaining his health and well-being. Options B, C, and D are not the immediate priorities in this situation. While an eye examination, oxygen use, and sensitivity tests are relevant aspects of care, addressing dehydration through increased fluid intake takes precedence in this scenario.

3. A client has a new prescription for clozapine. Which of the following instructions should the nurse include?

• A. You should have your white blood cell count checked regularly.
• B. You should take this medication on an empty stomach.
• C. You should avoid eating foods high in tyramine.
• D. You should avoid taking this medication with milk.

Correct answer: A

Rationale: The correct answer is A: 'You should have your white blood cell count checked regularly.' Clozapine can lead to agranulocytosis, a serious condition characterized by a low white blood cell count. Regular monitoring of the white blood cell count is crucial to detect this adverse effect early and prevent serious complications. Choices B, C, and D are incorrect because taking clozapine on an empty stomach, avoiding foods high in tyramine, or avoiding taking the medication with milk are not specific instructions related to the potential adverse effect of agranulocytosis associated with clozapine.

4. The healthcare professional is assisting in the care of a client diagnosed with heart failure. The client is receiving furosemide (Lasix). Which laboratory value should the healthcare professional monitor most closely?

• A. Serum calcium
• B. Serum potassium
• C. Serum sodium
• D. Serum glucose

Correct answer: B

Rationale: Furosemide is a loop diuretic that can lead to significant potassium loss, making it crucial to monitor the client's serum potassium levels. Hypokalemia (low potassium levels) can result from furosemide use, potentially leading to adverse effects such as cardiac dysrhythmias. Therefore, close monitoring of serum potassium levels is essential to prevent complications in clients receiving furosemide. Monitoring serum calcium, sodium, or glucose levels is not the priority when administering furosemide.

5. A nurse is assessing a client who has been taking levothyroxine for hypothyroidism. Which of the following findings should the nurse report to the provider?

• A. Weight loss
• B. Insomnia
• C. Heat intolerance
• D. Dry skin

Correct answer: C

Rationale: The correct answer is C: Heat intolerance. Heat intolerance is a sign of levothyroxine toxicity and requires immediate attention. Weight loss may actually be an expected outcome of levothyroxine therapy as it can help regulate metabolism in hypothyroidism. Insomnia can occur as a side effect of levothyroxine but is not as concerning as heat intolerance. Dry skin is a common symptom of hypothyroidism and may improve with levothyroxine therapy, so it is not a priority finding to report to the provider.

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