Nursing Elites

1. A female client reports that her hair is becoming coarse and breaking off, that the outer part of her eyebrows has disappeared, and that her eyes are puffy. What follow-up question is best for the nurse to ask?

• A. Have you noticed any changes in your fingernails?
• B. Have you had any changes in weight or energy levels?
• C. Do you have a family history of thyroid problems?
• D. Have you had recent cold intolerance or unusual fatigue?

Correct answer: D

Rationale: The correct answer is D. Cold intolerance, fatigue, and other changes may indicate hypothyroidism, which could explain the hair and eyebrow loss, and puffy eyes. Choices A, B, and C are less relevant in this context and do not directly address the symptoms presented by the client.

2. An older client with SIRS has a temperature of 101.8°F, a heart rate of 110 beats per minute, and a respiratory rate of 24 breaths per minute. Which additional finding is most important to report to the healthcare provider?

• A. Serum creatinine of 2.0 mg/dL
• B. Elevated WBC count
• C. Blood pressure of 100/60 mmHg
• D. Oxygen saturation of 95%

Correct answer: A

Rationale: A serum creatinine level of 2.0 mg/dL indicates possible acute kidney injury, which can occur during severe systemic inflammatory response syndrome (SIRS). Reporting this value promptly allows for interventions to prevent further renal damage. Elevated WBC count (choice B) is a common feature of SIRS and may not be as urgently indicative of immediate organ damage as high creatinine levels. A blood pressure of 100/60 mmHg (choice C) is relatively low but may be a typical finding in SIRS; however, renal function is critical in this context. Oxygen saturation of 95% (choice D) is within normal limits and is not as concerning as a high creatinine level in this scenario.

3. Which activity is most important for a client recovering from a hip replacement to avoid during the first few weeks of recovery?

• A. Sitting in a chair for short periods
• B. Crossing the legs while sitting
• C. Walking with assistance
• D. Performing light stretching exercises

Correct answer: B

Rationale: The correct answer is B: Crossing the legs while sitting. Cross-leg position after a hip replacement can significantly increase the risk of hip dislocation. During the first few weeks of recovery, it is crucial for clients to avoid crossing their legs to protect the new joint. Choices A, C, and D are not as critical during the initial recovery phase. Sitting in a chair for short periods, walking with assistance, and performing light stretching exercises are generally encouraged activities that can help in the recovery process without posing a significant risk of complications like hip dislocation.

4. A client with Type 1 diabetes reports feeling shaky and lightheaded. The nurse checks the client's blood glucose level and it is 60 mg/dL. What action should the nurse take first?

• A. Give the client a glucagon injection
• B. Encourage the client to eat a high-protein snack
• C. Recheck the blood glucose level in 15 minutes
• D. Administer 15 grams of a fast-acting carbohydrate

Correct answer: D

Rationale: The correct answer is D: Administer 15 grams of a fast-acting carbohydrate. The first step in treating hypoglycemia is to quickly raise the client's blood sugar level. Fast-acting carbohydrates like glucose tablets or juice are essential for this purpose. Giving a glucagon injection is typically reserved for severe hypoglycemia when the client is unable to take anything by mouth. Encouraging the client to eat a high-protein snack is not appropriate for immediate treatment of hypoglycemia. Rechecking the blood glucose level in 15 minutes is important after administering the fast-acting carbohydrate to ensure that the blood sugar has returned to a safe level.

5. A client with chronic obstructive pulmonary disease (COPD) is admitted with increasing shortness of breath. What is the nurse's priority action?

• A. Administer oxygen via nasal cannula.
• B. Reposition the client to improve breathing.
• C. Perform chest physiotherapy.
• D. Encourage the client to cough and deep breathe.

Correct answer: A

Rationale: The correct answer is A: Administer oxygen via nasal cannula. Oxygen therapy is the priority intervention for a client with COPD experiencing increasing shortness of breath. It helps improve oxygenation and relieve respiratory distress. Choice B is not the priority as oxygenation needs to be addressed first. Choice C, chest physiotherapy, may be beneficial but is not the immediate priority in this situation. Choice D, encouraging the client to cough and deep breathe, is not the priority intervention when oxygenation is compromised.

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