Nursing Elites

1. An adult female client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. After starting medication therapy, the nurse notices the client has more energy, is giving away her belongings, and has an elevated mood. Which intervention is best for the nurse to implement?

• A. Support the client by telling her what wonderful progress she is making.
• B. Ask the client if she has had any recent thoughts of harming herself.
• C. Reassure the client that the antidepressant drugs are apparently effective.
• D. Tell the client to keep her belongings because she will need them at discharge.

Correct answer: B

Rationale: When a client with major depressive disorder shows signs of increased energy, giving away belongings, and an elevated mood, it could indicate a shift towards suicidal behavior. Therefore, the best intervention for the nurse is to ask the client if she has had any recent thoughts of harming herself. This is crucial to assess the client's risk for suicide and provide necessary interventions. Choices A, C, and D are incorrect because they do not address the potential risk of harm to the client and do not prioritize the immediate assessment required in this situation.

2. A client with cirrhosis is admitted with ascites and jaundice. Which clinical finding is most concerning?

• A. Peripheral edema
• B. Increased abdominal girth
• C. Confusion and altered mental status
• D. Yellowing of the skin

Correct answer: C

Rationale: The correct answer is C. Confusion and altered mental status are the most concerning clinical findings in a client with cirrhosis because they may indicate hepatic encephalopathy, a serious complication that requires immediate intervention. Peripheral edema (choice A) and increased abdominal girth (choice B) are common manifestations of cirrhosis but are not as acutely concerning as signs of hepatic encephalopathy. Yellowing of the skin (choice D) is due to jaundice, which is already present in the client and does not directly indicate a worsening condition like confusion and altered mental status.

3. In caring for a client receiving the aminoglycoside antibiotic gentamicin, what diagnostic test should the nurse prioritize monitoring?

• A. Urinalysis
• B. Serum creatinine
• C. Serum osmolarity
• D. Liver enzymes

Correct answer: B

Rationale: The correct answer is B: Serum creatinine. Aminoglycosides, such as gentamicin, are known to cause nephrotoxicity, which can lead to kidney damage. Monitoring serum creatinine levels is crucial in assessing renal function and detecting any potential kidney problems early. Choices A, C, and D are incorrect because urinalysis primarily assesses urine composition, serum osmolarity measures the concentration of solutes in the blood, and liver enzymes are not directly impacted by aminoglycoside antibiotics like gentamicin.

4. In a client with liver cirrhosis admitted with ascites and jaundice, which laboratory value is most concerning to the nurse?

• A. Serum albumin of 3.0 g/dl
• B. Bilirubin of 3.0 mg/dl
• C. Ammonia level of 80 mcg/dl
• D. Prothrombin time of 18 seconds

Correct answer: C

Rationale: An elevated ammonia level of 80 mcg/dl is most concerning in a client with liver cirrhosis because it may indicate hepatic encephalopathy, a serious complication. Serum albumin, though low, is expected in cirrhosis and contributes to ascites. Bilirubin elevation is common in liver disease but may not be the most concerning in this case. Prothrombin time is typically prolonged in liver disease but may not be as acute as an elevated ammonia level suggesting hepatic encephalopathy.

5. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Elevate the head of the bed.
• C. Obtain a sputum culture.
• D. Administer antibiotics as prescribed.

Correct answer: A

Rationale: The correct answer is to administer oxygen therapy as prescribed. In COPD exacerbation, the priority is to improve oxygenation. Administering oxygen therapy helps ensure an adequate oxygen supply to the body's tissues. Elevating the head of the bed can improve ventilation but is not the first intervention needed in this situation. Obtaining a sputum culture and administering antibiotics are important in COPD exacerbation but come after ensuring proper oxygenation.

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