Nursing Elites

1. A nurse is assessing a newborn who has a blood glucose level of 30 mg/dl. Which of the following manifestations should the nurse expect?

• A. Loose stools.
• B. Jitteriness.
• C. Hypertonia.
• D. Abdominal distention.

Correct answer: B

Rationale: Corrected Rationale: Jitteriness is a common manifestation of hypoglycemia in newborns. Choice A, 'Loose stools,' is not typically associated with hypoglycemia in newborns. Choice C, 'Hypertonia,' is not a common manifestation of hypoglycemia in newborns; instead, hypotonia may be observed. Choice D, 'Abdominal distention,' is not a typical manifestation of hypoglycemia in newborns.

2. A client with a history of depression is experiencing a situational crisis. Which of the following actions should the nurse take first?

• A. Confirm the client's perception of the event.
• B. Notify the client's support system.
• C. Help the client identify personal strengths.
• D. Teach the client relaxation techniques.

Correct answer: A

Rationale: The correct answer is to confirm the client's perception of the event. In crisis intervention, understanding the client's perspective is crucial as it helps the nurse assess the situation accurately and provide tailored support. This step can also help build rapport and trust with the client. Option B, notifying the client's support system, may be important but should come after assessing the client's perception. Option C, helping the client identify personal strengths, and option D, teaching relaxation techniques, are valuable interventions but should follow the initial step of confirming the client's perception.

3. Which medication is used to treat opioid overdose?

• A. Naloxone
• B. Epinephrine
• C. Lidocaine
• D. Atropine

Correct answer: A

Rationale: Naloxone is the correct answer. Naloxone is the standard medication for reversing opioid overdose by blocking opioid receptors. Choice B, Epinephrine, is used to treat severe allergic reactions (anaphylaxis) and cardiac arrest, not opioid overdose. Choice C, Lidocaine, is a local anesthetic used for numbing purposes and managing certain types of arrhythmias, not for opioid overdose. Choice D, Atropine, is used to treat bradycardia, organophosphate poisoning, and nerve agent toxicity, not opioid overdose.

4. A nurse is caring for a client with schizophrenia. Which of the following assessment findings should the nurse expect?

• A. Decreased level of consciousness
• B. Inability to identify common objects
• C. Poor problem-solving ability
• D. Preoccupation with somatic disturbances

Correct answer: B

Rationale: In schizophrenia, clients often display an inability to identify common objects due to cognitive impairment. This is known as associative agnosia, where individuals struggle to recognize familiar objects, faces, or sounds. Choices A, C, and D are not typically associated with schizophrenia. Decreased level of consciousness is more indicative of conditions like head trauma or drug overdose. Poor problem-solving ability may be seen in various mental health disorders but is not specific to schizophrenia. Preoccupation with somatic disturbances is more commonly seen in somatic symptom disorders or somatic delusions, not a typical finding in schizophrenia.

5. A nurse is planning care for a client who is postoperative following a bowel resection. Which of the following interventions should the nurse include?

• A. Encourage the client to drink adequate fluids daily.
• B. Administer pain medication as needed.
• C. Instruct the client to splint the incision with a pillow.
• D. Encourage the client to eat a balanced diet.

Correct answer: C

Rationale: The correct intervention for a client post-bowel resection is to instruct the client to splint the incision with a pillow. This technique helps prevent dehiscence, which is the separation of wound edges, and reduces pain when coughing or moving. Splinting supports the incision site, decreasing tension on the wound. Encouraging the client to drink adequate fluids promotes hydration and aids in recovery, but a specific volume like 1,000 mL mentioned in choice A is not essential. Pain medication should be administered as needed for adequate pain control, not necessarily before every meal. Instructing the client to eat a balanced diet, including adequate protein, is crucial for wound healing and overall recovery, rather than limiting protein intake.

Similar Questions