Nursing Elites

1. A young adult woman visits the clinic and learns that she is positive for BRCA1 gene mutation and asks the nurse what to expect next. How should the nurse respond?

• A. Explain that counseling will be provided to give her information about her cancer risk.
• B. Gather additional information about the client’s family history for all types of cancer.
• C. Offer assurance that there are a variety of effective treatments for breast cancer.
• D. Provide information about survival rates for women who have this genetic mutation.

Correct answer: A

Rationale: The correct answer is A because counseling will help the woman understand her risk and options for surveillance or preventive measures. At this point, it is crucial to address the woman's immediate concerns related to the BRCA1 gene mutation. Choice B is incorrect as the focus should be on the woman's individual risk due to the specific gene mutation she carries. Choice C is not the priority as treatment options come after assessing the risk and deciding on surveillance or preventive measures. Choice D is incorrect because discussing survival rates is not the immediate need for someone who has just received information about having a genetic mutation.

2. When preparing to discharge a male client who has been hospitalized for an adrenal crisis, the client expresses concern about having another crisis. He tells the nurse that he wants to stay in the hospital a few more days. Which intervention should the nurse implement?

• A. Administer antianxiety medication before providing discharge instructions
• B. Schedule a follow-up appointment for an outpatient psychosocial assessment
• C. Obtain a blood cortisol level before discharge
• D. Encourage the client to remain in the hospital for a few more days

Correct answer: B

Rationale: The correct intervention is to schedule a follow-up appointment for an outpatient psychosocial assessment. This option addresses the client's concerns and provides support for managing stress and preventing future crises, which is crucial for the client's long-term care. Administering antianxiety medication before providing discharge instructions (Choice A) may not effectively address the underlying concerns. Obtaining a blood cortisol level before discharge (Choice C) is important but not the priority in this situation. Encouraging the client to remain in the hospital for a few more days (Choice D) is not the best course of action as it may not address the client's anxiety and could potentially lead to other issues.

3. A client who is newly diagnosed with type 2 diabetes mellitus (DM) receives a prescription for metformin (Glucophage) 500 mg PO twice daily. What information should the nurse include in this client’s teaching plan? (Select all that apply.)

• A. Take an additional dose for signs of hyperglycemia
• B. Recognize signs and symptoms of hypoglycemia.
• C. Report persistent polyuria to the healthcare provider.
• D. Use sliding scale insulin for finger stick glucose elevation.

Correct answer: D

Rationale: The correct answer is D. Metformin does not require additional doses for hyperglycemia, and sliding scale insulin is not typically used with metformin. It is important for the client to recognize signs and symptoms of hypoglycemia, report persistent polyuria to the healthcare provider, and take the medication with meals. Teaching the client to use sliding scale insulin for finger stick glucose elevation is not appropriate in this case because metformin is the prescribed medication, and its mechanism of action differs from insulin therapy. The client should be educated on the importance of taking metformin with meals to reduce gastrointestinal side effects and to report any persistent polyuria, which could indicate poor blood sugar control.

4. The charge nurse of a cardiac telemetry unit is assigning client care to a registered nurse (RN) and a practical nurse (PN). Which client should be assigned to the RN?

• A. One day after a permanent pacemaker insertion, a client's telemetry monitor shows a pacer rhythm.
• B. Two hours after undergoing cardioversion, a client's telemetry monitor shows a normal sinus rhythm.
• C. A client started on carvedilol the previous day for heart failure has controlled atrial fibrillation.
• D. Four hours after admission, a client with syncope shows complete heart block on the telemetry monitor.

Correct answer: D

Rationale: The correct answer is D because complete heart block is a critical condition that requires immediate assessment and management by a registered nurse (RN). In complete heart block, there is a significant conduction disturbance that can lead to serious complications. The RN is better equipped to handle such complex and potentially life-threatening situations. Choices A, B, and C involve less critical conditions that can be managed by a practical nurse (PN) under the supervision of the RN. Therefore, assigning the client with complete heart block to the RN ensures prompt and appropriate intervention.

5. An older male client is admitted to the mental health unit with a sudden onset of global disorientation and is continuously conversing with his mother, who died 50 years ago. The nurse reviews the multiple prescriptions the client is currently taking and assesses his urine specimen, which is cloudy, dark yellow, and has a foul odor. These findings suggest that this client is experiencing which condition?

• A. Psychotic episode
• B. Dementia
• C. Delirium
• D. Depression

Correct answer: C

Rationale: The correct answer is C, delirium. The sudden onset of global disorientation along with cloudy, dark yellow urine with a foul odor are indicative of delirium. Delirium is an acute condition characterized by a fluctuating disturbance in awareness and cognition. In this case, the symptoms are suggestive of an underlying physiological cause, such as infection or medication side effects. Choice A, psychotic episode, is less likely as the symptoms are more in line with delirium than a primary psychotic disorder. Choice B, dementia, is a chronic and progressive condition, not typically presenting with sudden onset disorientation. Choice D, depression, does not align with the acute cognitive changes and urine abnormalities described in the scenario.

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