Nursing Elites

1. A female client complains to the nurse at the health department that she has fatigue, shortness of breath, and lightheadedness. Her history reveals no significant medical problems. She states that she is always on a fad diet without any vitamin supplements. Which tests should the nurse expect the client to have first?

• A. peptic ulcer studies
• B. complete blood count, including hematocrit and hemoglobin
• C. genetic testing
• D. hemoglobin electrophoresis

Correct answer: B

Rationale: The correct answer is to perform a complete blood count, including hematocrit and hemoglobin, as the initial tests to assess the client's symptoms related to fatigue, shortness of breath, and lightheadedness. These symptoms can be indicative of anemia, which can be caused by nutritional deficiencies due to fad dieting without vitamin supplements. Peptic ulcer studies, genetic testing, and hemoglobin electrophoresis are not the most appropriate initial tests for the client's presenting symptoms and history. Peptic ulcer studies are not relevant to the client's symptoms. Genetic testing is not indicated based on the client's presentation and history. Hemoglobin electrophoresis is used to diagnose specific types of anemia and is not the first-line test in this scenario. Further testing decisions should be based on the results of the initial tests, the client's history, and other relevant factors.

2. A client comes to the clinic for assessment of his physical status and guidelines for starting a weight-reduction diet. The client's weight is 216 pounds and his height is 66 inches. The nurse identifies the BMI (body mass index) as:

• A. within normal limits, so a weight-reduction diet is unnecessary
• B. lower than normal, so education about nutrient-dense foods is needed
• C. indicating obesity because the BMI is 35
• D. indicating overweight status because the BMI is 27

Correct answer: C

Rationale: Obesity is defined by a BMI of 30 or more with no co-morbid conditions. It is calculated by utilizing a chart or nomogram that plots height and weight. This client's BMI is 35, indicating obesity. Choices A, B, and D are incorrect because the client's BMI is above 30, which falls under the obesity category. Therefore, a weight-reduction diet and increased physical activity are necessary to address the client's weight status and promote overall health.

3. Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in clients with hypothyroidism because:

• A. it is chemically stable, nonallergenic, and can be administered orally once a day.
• B. it is available in a wide range of concentrations to meet individual client requirements.
• C. it is a prodrug of T3.
• D. it has a long half-life.

Correct answer: A

Rationale: Levothyroxine (Synthroid) is the preferred medication for hypothyroidism due to its chemical stability, nonallergenic properties, and convenient once-daily oral administration. It is safe and effective with minimal side effects when appropriately dosed. Choice B is incorrect because while Levothyroxine is available in various concentrations, it is not the reason it is the drug of choice; the primary reason is its stability and nonallergenic nature. Choice C is wrong as Levothyroxine (T4) is not a prodrug of T3; it is converted to T3 in the body. Option D is inaccurate because Levothyroxine has a long half-life (around 7 days), enabling once-daily dosing, as opposed to a short half-life.

4. If a client is suffering from thyroid storm, the PN can expect to find on assessment:

• A. tachycardia and hyperthermia.
• B. bradycardia and hypothermia.
• C. a large goiter.
• D. a calm, quiet client

Correct answer: A

Rationale: In thyroid storm, there is an excess of thyroxine, leading to symptoms such as tachycardia (rapid heart rate) and hyperthermia (increased body temperature). Atrial fibrillation and palpitations are also commonly observed. Choices B and C are more indicative of hypothyroidism, where the thyroid is underactive, leading to bradycardia (slow heart rate), hypothermia (decreased body temperature), and the development of a large goiter. Choice D, a calm, quiet client, is unlikely in a thyroid storm where the individual would typically present with symptoms of agitation and restlessness due to the hypermetabolic state.

5. During a stress test, a patient complains of severe chest pain. Which of the following medications is the most appropriate to relieve this discomfort?

• A. Aspirin
• B. Diazoxide
• C. Procardia
• D. Mannitol

Correct answer: C

Rationale: In this scenario, the most appropriate medication to relieve severe ischemic chest pain during a stress test is Procardia. Procardia, a calcium channel blocker, is effective in quickly alleviating chest pain by dilating coronary arteries, improving blood flow to the heart muscle. Aspirin, although important for antiplatelet effects, is not the best choice for immediate relief of severe chest pain. Diazoxide is a vasodilator used in hypertensive emergencies, not for acute chest pain. Mannitol is an osmotic diuretic used to reduce intracranial pressure, not for chest pain relief.

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