Nursing Elites

1. A client with end-stage pulmonary disease requests 'no heroic measures' if she stops breathing. What should the nurse do next?

• A. Document the client's request in the medical record.
• B. Ask the client to discuss a DNR order with her healthcare provider.
• C. Consult the ethics committee for guidance.
• D. Discharge the client with no further discussion.

Correct answer: B

Rationale: The correct next step for the nurse is to ask the client to discuss a 'do not resuscitate' (DNR) order with her healthcare provider. While the client's wishes should be respected, it is essential to ensure proper documentation and legal protection by involving the healthcare provider in this decision-making process. Documenting the request in the medical record (Choice A) is important but should follow the discussion with the healthcare provider. Consulting the ethics committee (Choice C) may not be necessary at this stage and could delay the necessary actions. Discharging the client (Choice D) without further discussion is not appropriate and disregards the importance of addressing the client's wishes in a respectful and professional manner.

2. Which foods should a healthcare provider recommend for a child with phenylketonuria (PKU) to avoid?

• A. Fresh fruit and vegetables
• B. Foods sweetened with aspartame
• C. Bread with honey
• D. Gluten-rich bread

Correct answer: B

Rationale: The correct answer is B: 'Foods sweetened with aspartame.' Children with PKU must avoid foods containing aspartame because it breaks down into phenylalanine, which can worsen their condition. Choice A, fresh fruit and vegetables, are generally healthy and safe for individuals with PKU. Choice C, bread with honey, is also safe unless the bread contains artificial sweeteners like aspartame. Choice D, gluten-rich bread, is not specifically problematic for individuals with PKU unless it contains aspartame or other substances high in phenylalanine.

3. An older client is admitted with fluid volume deficit and dehydration. Which assessment finding is the best indicator of hydration status?

• A. Urine specific gravity of 1.040.
• B. Systolic blood pressure decreases by 10 points when standing.
• C. The client denies feeling thirsty.
• D. Skin turgor exhibits tenting on the forearm.

Correct answer: A

Rationale: In the context of fluid volume deficit and dehydration, urine specific gravity of 1.040 is the best indicator of hydration status. High urine specific gravity indicates concentrated urine, suggesting dehydration. Choice B, systolic blood pressure decreasing when standing, is more indicative of orthostatic hypotension rather than hydration status. Choice C, denial of thirst, is a subjective finding and may not always reflect actual hydration status. Choice D, skin turgor exhibiting tenting on the forearm, is a sign of dehydration but may not be as accurate as urine specific gravity in assessing hydration status.

4. A client with hypothyroidism is prescribed levothyroxine. What is the most important teaching point for the nurse to provide?

• A. Take the medication with food to avoid stomach upset.
• B. Take the medication at the same time every day to maintain consistent thyroid levels.
• C. Expect increased sensitivity to cold as a side effect of the medication.
• D. Increase the dosage of levothyroxine if symptoms worsen.

Correct answer: B

Rationale: The correct answer is B. Levothyroxine should be taken at the same time every day to maintain stable thyroid hormone levels and ensure effective management of hypothyroidism. Consistent dosing is critical for preventing fluctuations in hormone levels. Choice A is incorrect because levothyroxine is usually recommended to be taken on an empty stomach for optimal absorption. Choice C is incorrect because increased sensitivity to cold is not a common side effect of levothyroxine. Choice D is incorrect because adjusting the dosage without healthcare provider guidance can be dangerous and should not be done independently.

5. A client is admitted to the emergency department after a motor vehicle accident. The client has a Glasgow Coma Scale (GCS) score of 10. What does this score indicate?

• A. Mild impairment
• B. Moderate impairment
• C. Severe impairment
• D. Normal

Correct answer: B

Rationale: A Glasgow Coma Scale score of 10 falls into the range of moderate impairment, indicating the need for further assessment and monitoring. A GCS score of 10 suggests that the client is moderately impaired neurologically. Choices A, C, and D are incorrect because a GCS score of 10 does not indicate mild impairment, severe impairment, or normal neurological status, respectively.

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