Nursing Elites

1. An adult client with severe depression was admitted to the psychiatric unit yesterday evening. Although the client used to run a year ago, his spouse states that the client no longer runs but sits and watches television most of the day. Which is most important for the nurse to include in this client’s plan of care for today?

• A. Assist the client in identifying goals for the day
• B. Encourage the client to participate in a team sport for one hour
• C. Schedule the client for a group session that focuses on self-esteem
• D. Help the client develop a list of daily affirmations

Correct answer: A

Rationale: Assisting the client in identifying goals for the day is the most important aspect of the plan of care for a client with severe depression. Setting achievable daily goals helps engage the client in activities and promotes a sense of accomplishment, which can contribute to gradual improvement in their condition. Encouraging participation in team sports may be overwhelming for a client with severe depression as it requires a significant level of energy and motivation that the client may not possess at this time. Group sessions focusing on self-esteem and daily affirmations are beneficial interventions, but they may not have an immediate impact compared to setting achievable daily goals that can provide a sense of purpose and achievement for the client.

2. A heparin infusion is prescribed for a client who weighs 220 pounds. After administering a bolus dose of 80 units/kg, the nurse calculates the infusion rate for the heparin sodium at 18 units/kg/hour. The available solution is Heparin Sodium 25,000 units in 5% Dextrose Injection 250 ml. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 18
• B. 27
• C. 36
• D. 45

Correct answer: B

Rationale: To calculate the infusion rate, first, find the total dose required per hour, which is the patient's weight (220 pounds) multiplied by the prescribed rate (18 units/kg/hour). This equals 3960 units/hour. Next, determine how many ml of the solution contain 25,000 units; this is 250 ml. Divide the total dose required per hour (3960 units) by the units per ml (25,000 units/250 ml) to find how many ml are needed per hour. This results in 27 ml/hour. Therefore, the nurse should program the infusion pump to deliver 27 ml/hour. Choice A (18) is incorrect as it does not account for the concentration of the heparin solution. Choices C (36) and D (45) are incorrect as they do not reflect the accurate calculations based on the patient's weight and the heparin concentration in the solution.

3. A male client with hypercholesterolemia wants to change his diet to help reduce his cholesterol levels. Which breakfast items should the nurse encourage the client to eat? (Select all that apply)

• A. Sausage patties and eggs
• B. Whole wheat toast and jam
• C. Bagels and cream cheese
• D. Blackberries and oatmeal

Correct answer: B

Rationale: The correct choices are whole wheat toast and jam (B) and blackberries and oatmeal (D). Whole wheat toast and blackberries are high in fiber, which can help lower cholesterol levels. Sausage patties and eggs (A) are high in saturated fats that can raise cholesterol levels. Bagels and cream cheese (C) are not as beneficial for cholesterol control compared to high-fiber options like whole wheat toast and blackberries.

4. When attempting to establish risk reduction strategies in a community, the nurse notes that regional studies indicate a high number of persons with growth stunting and irreversible mental deficiencies caused by hypothyroidism (cretinism). The nurse should seek funding to implement which screening measure?

• A. T3 levels in school-aged children
• B. T4 levels in newborns
• C. TSH levels in women over 45
• D. Iodine levels in all persons over 60

Correct answer: B

Rationale: Screening T4 levels in newborns is crucial as it helps in the early detection of hypothyroidism, which can prevent conditions like cretinism. Checking T3 levels in school-aged children (Choice A) is not the most appropriate measure for early detection of hypothyroidism in newborns. Monitoring TSH levels in women over 45 (Choice C) is not directly related to detecting hypothyroidism in newborns. Additionally, monitoring iodine levels in all persons over 60 (Choice D) is not specifically aimed at early detection of hypothyroidism in newborns, which is crucial to prevent cretinism.

5. A mother brings her child, who has a history of asthma, to the emergency room. The child is wheezing and speaking one word between each breath. The child is anxious, tachycardic, and has labored respirations. Which assessment is most important for the nurse to obtain?

• A. Type of inhaler the child typically uses on a regular basis
• B. Frequency of rescue inhaler use during the week
• C. Last dose and type of rescue inhaler used by the child
• D. Type of allergen exposure or trigger for the current episode

Correct answer: C

Rationale: The correct answer is C because knowing the last dose and type of rescue inhaler used helps assess if the child has received adequate treatment and if further intervention is needed. This information is crucial in managing an acute asthma exacerbation. Choice A, the type of inhaler the child typically uses, is less critical during an emergency. Choice B, the frequency of rescue inhaler use during the week, is important for general asthma management but does not provide immediate guidance in the acute situation. Choice D, the type of allergen exposure or trigger, is more relevant for preventive strategies and does not directly impact the immediate treatment of the child's acute asthma attack.

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