Nursing Elites

1. A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, Nurse Tyzz notes that the client is agitated, irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

• A. Depression
• B. Neuropathy
• C. Hypoglycemia
• D. Hyperthyroidism

Correct answer: A

Rationale: The correct answer is A: Depression. Depression is a common psychological manifestation in clients with Cushing's syndrome. In this scenario, the client's symptoms of agitation, irritability, poor memory, loss of appetite, and disheveled appearance are indicative of depressive symptoms rather than neuropathy, hypoglycemia, or hyperthyroidism. Neuropathy typically presents with sensory changes and motor deficits, which are not described in the scenario. Hypoglycemia would manifest with symptoms such as diaphoresis, tremors, and confusion, which are not mentioned. Hyperthyroidism symptoms include weight loss, heat intolerance, and palpitations, which are not consistent with the client's presentation.

2. Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

• A. 1130 and 1330.
• B. 1330 and 1930.
• C. 1530 and 2130.
• D. 1730 and 2330.

Correct answer: C

Rationale: NPH insulin typically peaks 4-12 hours after administration, so a peak between 1530 and 2130 would be expected. Choice A (1130 and 1330) is too early for the peak effect of NPH insulin. Choice B (1330 and 1930) falls within the possible peak period but is not as accurate as choice C. Choice D (1730 and 2330) is too late for the peak effect of NPH insulin based on the typical peak timing.

3. A healthcare professional is reviewing the medication orders for a client with hypothyroidism. Which of the following medications should the healthcare professional question?

• A. Levothyroxine
• B. Amiodarone
• C. Calcium supplements
• D. Aspirin

Correct answer: B

Rationale: The correct answer is B: Amiodarone. Amiodarone can affect thyroid function and potentially worsen hypothyroidism, so its use should be carefully considered or questioned in clients with this condition. Levothyroxine (Choice A) is the mainstay therapy for hypothyroidism and should not be questioned in this scenario. Calcium supplements (Choice C) are not typically contraindicated in clients with hypothyroidism and may be needed if there is a deficiency. Aspirin (Choice D) is not directly related to thyroid function and is not a medication that would typically be questioned in a client with hypothyroidism.

4. A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level?

• A. The client with colitis
• B. The client with Cushing's syndrome
• C. The client who has been overusing laxatives
• D. The client who has sustained a traumatic burn

Correct answer: D

Rationale: Clients who have sustained traumatic burns are at a higher risk of developing hyperkalemia due to cell lysis. When cells are damaged in a traumatic burn, potassium can leak out from the intracellular space into the bloodstream, leading to elevated serum potassium levels. Colitis, Cushing's syndrome, and overuse of laxatives are not typically associated with the same degree of cell damage or potassium shifts seen in traumatic burns, making them less likely to result in such high potassium levels.

5. Which of the following ethical principles is involved when a healthcare provider allows a patient to refuse treatment?

• A. Autonomy
• B. Nonmaleficence
• C. Beneficence
• D. Justice

Correct answer: A

Rationale: The correct answer is A: Autonomy. Autonomy is the ethical principle that respects an individual's right to make their own decisions, including the right to refuse treatment. This principle acknowledges the patient's self-governance and independence in making choices about their own healthcare. Choice B, Nonmaleficence, refers to the ethical principle of doing no harm and ensuring patient safety. Choice C, Beneficence, involves promoting the patient's well-being and acting in their best interest. Choice D, Justice, pertains to fairness and equitable distribution of healthcare resources.

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