Nursing Elites

1. A female client with major depressive disorder tells the nurse she feels worthless and can't see how her life will ever get better. What is the best response by the nurse?

• A. I can understand how you feel. Tell me more about what's been going on.
• B. You're going through a tough time. Let's discuss what makes you feel this way.
• C. You sound very hopeless right now. Are you thinking about harming yourself?
• D. It's difficult to see the light when you're feeling this way, but I'm here to help you.

Correct answer: C

Rationale: Choice C is the best response because it directly addresses the client's expressed hopelessness and assesses the risk for self-harm. When a client with major depressive disorder expresses feeling worthless and unable to see improvement, it is essential to assess suicidal ideation to ensure their safety. Choices A, B, and D provide empathy and support, which are important but addressing suicidal ideation is the priority in this situation.

2. A client with a history of chronic kidney disease (CKD) is receiving erythropoietin therapy. Which laboratory value should the nurse monitor closely?

• A. Serum potassium level
• B. White blood cell count
• C. Hemoglobin level
• D. Serum calcium level

Correct answer: A

Rationale: The correct answer is A: Serum potassium level. In a client receiving erythropoietin therapy for chronic kidney disease, monitoring serum potassium levels is crucial due to the risk of hyperkalemia. Erythropoietin can stimulate red blood cell production, leading to an increased demand for potassium. Monitoring potassium levels helps prevent complications associated with hyperkalemia. Choices B, C, and D are incorrect because erythropoietin therapy specifically impacts potassium levels, not white blood cell count, hemoglobin level, or serum calcium level.

3. A client with a nasogastric tube in place following gastric surgery reports nausea. What is the most appropriate nursing action?

• A. Irrigate the NG tube with 30 ml of normal saline.
• B. Administer an antiemetic as prescribed.
• C. Assess the NG tube for patency and reposition if necessary.
• D. Provide sips of water and reassess the client's symptoms.

Correct answer: C

Rationale: Assessing the NG tube for patency and repositioning it if necessary is the most appropriate action to relieve the client's nausea. Nausea in a client with a nasogastric tube can be due to the tube's malposition or blockage. Irrigating the NG tube with normal saline (Choice A) without assessing for patency or repositioning may worsen the situation. Administering an antiemetic (Choice B) can help manage symptoms but does not address the potential issue with the NG tube. Providing sips of water and reassessing symptoms (Choice D) may be contraindicated if there is a problem with the NG tube and could exacerbate the nausea.

4. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which assessment finding requires immediate intervention?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 24 breaths per minute
• C. Use of accessory muscles
• D. Inspiratory crackles

Correct answer: C

Rationale: The correct answer is C: Use of accessory muscles. In a client with COPD and pneumonia, the use of accessory muscles indicates increased work of breathing and may signal respiratory failure. Immediate intervention is necessary to prevent further deterioration of the respiratory status. Choice A, an oxygen saturation of 90%, though low, may not require immediate intervention as it is above the typical threshold for initiating supplemental oxygen. Choice B, a respiratory rate of 24 breaths per minute, falls within the normal range for an adult and may not be an immediate cause for concern. Choice D, inspiratory crackles, are indicative of fluid in the lungs but may not require immediate intervention unless accompanied by other concerning signs like decreased oxygen saturation or increased respiratory distress.

5. Which assessment finding indicates to the nurse a client's readiness for pulmonary function tests?

• A. Expresses an understanding of the procedure.
• B. NPO for 6 hrs.
• C. No known drug allergies.
• D. Intravenous access intact.

Correct answer: A

Rationale: The correct answer is A: 'Expresses an understanding of the procedure.' This choice indicates that the client is mentally prepared for the pulmonary function tests, as understanding the procedure shows readiness and cooperation. Choices B, C, and D are incorrect. Choice B, 'NPO for 6 hrs,' pertains to fasting status and is not directly related to readiness for the test. Choice C, 'No known drug allergies,' is important information but does not specifically indicate readiness for pulmonary function tests. Choice D, 'Intravenous access intact,' is related to vascular access and not a direct indicator of readiness for the pulmonary function tests.

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