Nursing Elites

1. A client with rheumatoid arthritis is receiving methotrexate (Rheumatrex). The nurse should monitor the client for which of the following adverse effects?

• A. Leukopenia
• B. Hyperglycemia
• C. Hypertension
• D. Hypokalemia

Correct answer: A

Rationale: The correct answer is A: Leukopenia. Methotrexate, used in the treatment of rheumatoid arthritis, can lead to bone marrow suppression, resulting in leukopenia. This condition increases the risk of infections due to decreased white blood cell count. Choices B, C, and D are incorrect because methotrexate is not known to cause hyperglycemia, hypertension, or hypokalemia as its primary adverse effects.

2. A client was admitted with a diagnosis of pneumonia. When auscultating the client's breath sounds, the nurse hears inspiratory crackles in the right base. Temperature is 102.3 degrees Fahrenheit orally. What finding would the nurse expect?

• A. Flushed skin
• B. Bradycardia
• C. Mental confusion
• D. Hypotension

Correct answer: C

Rationale: The correct answer is C: Mental confusion. In this scenario, the client's high fever and pneumonia diagnosis indicate an infection. Infections, especially in older adults, can lead to mental confusion due to the body's systemic response to the infection. Flushed skin (choice A) is more commonly associated with fever but does not specifically relate to the client's condition. Bradycardia (choice B) and hypotension (choice D) are less likely findings in a client with pneumonia and a high fever; instead, tachycardia and increased blood pressure are more commonly seen in response to infection.

3. The family presents several problems. Which of the following criteria is considered in determining the priority health problem?

• A. expected consequence of the problem
• B. cooperation and support of the family
• C. involvement of the family members in the problem
• D. modifiability of the problem

Correct answer: D

Rationale: When determining the priority health problem within a family, one key criterion to consider is the modifiability of the problem. This means assessing whether the health issue can be changed or improved through interventions. Choices A, B, and C are not directly related to the priority of the health problem within the family. The expected consequence of the problem, cooperation and support of the family, and involvement of family members are important factors but do not specifically address the priority of the health issue based on modifiability.

4. What title should be given to this occupational health nurse job description? A registered nurse who functions in a comprehensive executive role to set goals, formulate policy, and direct and evaluate the health service.

• A. manager
• B. researcher
• C. health educator
• D. health promotion specialist

Correct answer: A

Rationale: The correct answer is 'manager.' In the job description provided, the role involves setting goals, formulating policy, and directing and evaluating health services, which aligns with the responsibilities of a manager. A 'researcher' primarily focuses on conducting research, a 'health educator' specializes in educating individuals about health-related topics, and a 'health promotion specialist' concentrates on promoting health and wellness initiatives. Therefore, 'manager' is the most suitable title for the described role.

5. During a visit to the community health clinic, a 45-year-old Native American female, who has a BMI of 35, complains of changes in her vision. Which condition is most important for the RN to be aware of in the client's family history?

• A. Diabetes
• B. Glaucoma
• C. Hypertension
• D. Brain Tumor

Correct answer: A

Rationale: The correct answer is A: Diabetes. Given the client's Native American ethnicity, high BMI, and vision changes, diabetes is the most crucial condition for the nurse to be aware of in the client's family history. Diabetes is strongly associated with vision problems, especially diabetic retinopathy. Glaucoma (choice B) is a condition that affects the optic nerve and can lead to vision loss but is not as directly linked to the client's BMI and ethnic background. Hypertension (choice C) can also impact vision, but in this case, diabetes takes precedence based on the client's profile. Brain tumor (choice D) is less likely to be related to the client's BMI, ethnicity, and vision changes compared to diabetes.

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