Nursing Elites

1. A client with pheochromocytoma is admitted to the hospital. Which intervention has the highest priority?

• A. Monitor blood pressure frequently
• B. Start intravenous fluids at a fast rate
• C. Administer pain medication to reduce discomfort
• D. Give antihypertensive medications as prescribed

Correct answer: B

Rationale: The correct answer is B: Start intravenous fluids at a fast rate. In a client with pheochromocytoma, the highest priority intervention is to ensure adequate intravascular volume before initiating any other treatment. This helps prevent a sudden drop in blood pressure that can occur due to the release of catecholamines during tumor manipulation. While monitoring blood pressure frequently is essential, ensuring adequate intravascular volume takes precedence. Administering pain medication and antihypertensive medications are important but are not the highest priority in the initial management of pheochromocytoma.

2. Which client is at greatest risk for developing delirium?

• A. An adult client who cannot sleep due to pain.
• B. An older client who attempted suicide 1 month ago.
• C. A young adult taking antipsychotic medications twice daily.
• D. A middle-aged woman using supplemental oxygen.

Correct answer: B

Rationale: The correct answer is B. Older adults who have attempted suicide are at higher risk for developing delirium, especially in the context of underlying mental health conditions. Choice A is incorrect as sleep disturbances due to pain may lead to discomfort but not necessarily delirium. Choice C is incorrect as taking antipsychotic medications, if managed well, does not inherently increase the risk of delirium. Choice D is incorrect as using supplemental oxygen alone does not significantly increase the risk of developing delirium.

3. The nurse is teaching a group of clients about managing diabetes. Which of the following should be emphasized as a goal for all diabetics?

• A. Frequent exercise and weight control
• B. Prevent eye damage
• C. Keep insulin refrigerated at all times
• D. Prevent the development of complications

Correct answer: A

Rationale: The correct answer is A: Frequent exercise and weight control. These should be emphasized as a goal for all diabetics because they help prevent complications and manage blood sugar levels. Regular physical activity and maintaining a healthy weight are crucial in managing diabetes as they can improve insulin sensitivity, regulate blood sugar levels, and reduce the risk of cardiovascular complications. Choice B, preventing eye damage, is important but is more specific to diabetic retinopathy and not a general goal for all diabetics. Choice C, keeping insulin refrigerated, is essential for insulin storage but not a primary goal for all diabetics. Choice D, preventing the development of complications, is too broad and does not provide a specific actionable goal for all diabetics.

4. The nurse is providing discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further teaching?

• A. I will avoid crossing my legs when sitting.
• B. I will use a raised toilet seat to prevent bending too far.
• C. I should keep my legs together to prevent dislocation.
• D. I will use a walker when moving around initially.

Correct answer: C

Rationale: The correct answer is C. Clients who have had a hip replacement should not keep their legs together to prevent dislocation. This position increases the risk of hip dislocation. Choices A, B, and D are correct statements. Avoiding crossing legs, using a raised toilet seat to prevent excessive bending, and using a walker when moving around initially are all appropriate measures to ensure proper recovery and prevent complications after a total hip replacement.

5. A client presents to the labor and delivery unit with a report of leaking fluid that is greenish-brown vaginal discharge. Which action should the nurse take first?

• A. Notify the healthcare provider immediately
• B. Begin continuous fetal monitoring
• C. Check the amniotic fluid pH
• D. Assess maternal vital signs

Correct answer: B

Rationale: Greenish-brown discharge likely indicates meconium in the amniotic fluid, which poses a risk to the fetus. Continuous fetal monitoring should be initiated immediately to assess for signs of fetal distress. Meconium-stained amniotic fluid can lead to meconium aspiration syndrome in the newborn, so timely monitoring is crucial. Checking the amniotic fluid pH can help confirm the presence of meconium but is not the priority over fetal monitoring. Assessing maternal vital signs is important but secondary to monitoring the fetal well-being in this urgent situation. Notifying the healthcare provider can follow once the immediate fetal assessment is underway.

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