Nursing Elites

1. A client with hypothyroidism is started on levothyroxine (Synthroid). Which statement by the client indicates a need for further teaching?

• A. I will take this medication every morning before breakfast.
• B. I should have my thyroid levels checked regularly.
• C. If I lose weight, I may need an increased dose.
• D. I can stop taking this medication once my symptoms improve.

Correct answer: D

Rationale: The correct answer is D. Levothyroxine is typically a lifelong therapy for hypothyroidism. It should not be discontinued even if symptoms improve because the medication helps replace the deficient thyroid hormone. Stopping the medication prematurely can lead to a recurrence of symptoms and potential complications. Patients must understand the importance of continuous levothyroxine therapy and the necessity of regular follow-up with their healthcare provider to monitor thyroid levels and adjust the dosage as needed.

2. A client with cirrhosis is at risk for bleeding. Which laboratory test is most important to monitor?

• A. Blood glucose
• B. Serum creatinine
• C. Prothrombin time (PT)
• D. Electrolytes

Correct answer: C

Rationale: In clients with cirrhosis, monitoring the Prothrombin time (PT) is crucial as it assesses the blood's ability to clot. Cirrhosis can lead to impaired liver function, affecting the synthesis of clotting factors, hence increasing the risk of bleeding. Maintaining a close watch on PT levels helps in timely intervention to prevent excessive bleeding episodes. Blood glucose (Choice A) is not directly related to the clotting function; serum creatinine (Choice B) and electrolytes (Choice D) are important, but in cirrhosis, monitoring PT takes precedence due to the increased bleeding risk.

3. What is the primary action of digoxin when prescribed to a patient with heart failure?

• A. Increase heart rate
• B. Decrease cardiac output
• C. Strengthen cardiac contractions
• D. Lower blood pressure

Correct answer: C

Rationale: Digoxin, when prescribed to a patient with heart failure, primarily acts by strengthening cardiac contractions. This leads to an improvement in cardiac output, making it an essential medication in managing heart failure. By enhancing the force of contractions, digoxin helps the heart pump more effectively and efficiently, leading to better circulation and symptom control in patients with compromised cardiac function.

4. When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?

• A. Use glycerin suppositories on a regular basis
• B. Limit physical activity in order to promote bowel peristalsis
• C. Consume high-residue, high-fiber foods
• D. Resist the urge to defecate until the urge becomes intense

Correct answer: C

Rationale: Consuming high-residue, high-fiber foods is essential in promoting normal bowel function and preventing constipation. These foods help add bulk to the stool, making it easier to pass and preventing constipation. Glycerin suppositories may provide short-term relief but are not a long-term solution for chronic constipation. Physical activity actually helps promote bowel peristalsis, so limiting it would not be beneficial. Delaying defecation can lead to stool hardening and worsening constipation.

5. What instructions should the nurse give to a patient with cervical cancer who is planned to receive external-beam radiation to prevent complications from the effects of the radiation?

• A. Test stools for the presence of blood.
• B. Maintain a low-residue, high-fiber diet.
• C. Clean the perianal area carefully after every bowel movement.
• D. Inspect the mouth and throat daily for signs of thrush.

Correct answer: C

Rationale: When a patient with cervical cancer is receiving external-beam radiation, the radiation to the abdomen can affect organs in its path, such as the bowel, leading to complications like frequent diarrhea. Cleaning the perianal area carefully after each bowel movement is crucial to decrease the risk of skin breakdown and infection. Testing stools for blood is not necessary since inflammation associated with radiation may lead to occult blood in stools. Maintaining a low-residue diet is actually recommended to prevent bowel irritation. Radiation to the abdomen does not cause stomatitis, so inspecting the mouth and throat for thrush is not directly related to the effects of external-beam radiation in this context.

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