Nursing Elites

1. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report?

• A. Look at last quarter's hemoglobin and hematocrit to assess for dehydration.
• B. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage.
• C. Expect to find an increase in today's APTT compared to last quarter's due to bleeding.
• D. Determine if there is a decrease in serum potassium due to renal compromise.

Correct answer: B

Rationale: When a client increases their daily doses of acetaminophen for joint pain, it raises concerns about possible liver damage due to acetaminophen overdose. LDH (Lactate Dehydrogenase) levels can indicate liver function, so comparing today's levels with previous ones can help assess for liver damage caused by acetaminophen overuse.

2. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

3. A patient with heart failure is prescribed digoxin. What is the most important instruction the nurse should provide?

• A. Take an extra dose if you miss one.
• B. Avoid high-potassium foods.
• C. Report any visual disturbances.
• D. Stop taking the medication if your pulse is normal.

Correct answer: C

Rationale: The correct answer is C: 'Report any visual disturbances.' Patients taking digoxin should be instructed to report any visual disturbances, as this can be a sign of digoxin toxicity. Visual disturbances like changes in color vision, blurred vision, or seeing halos around lights can indicate an overdose of digoxin. Choices A, B, and D are incorrect. Instructing a patient to take an extra dose if they miss one can lead to overdose. Avoiding high-potassium foods is important for patients on potassium-sparing diuretics, not digoxin. Stopping the medication if the pulse is normal is incorrect, as the pulse rate alone is not an indicator of digoxin effectiveness or toxicity.

4. When covering another nurse's assignment during a lunch break, based on the status report provided, which client should the charge nurse check first?

• A. The client admitted yesterday with diabetic ketoacidosis whose blood glucose level is now 195 mg/dl.
• B. The client with an ileal conduit created two days ago with a scant amount of blood in the drainage pouch.
• C. The client post-triple coronary bypass four days ago who has serosanguinous drainage in the chest tube.
• D. The client with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of 90%.

Correct answer: D

Rationale: The client with a pneumothorax and a pulse oximeter reading of 90% indicates potential respiratory compromise, requiring immediate attention to prevent further deterioration.

5. A patient with bipolar disorder is prescribed lithium. What dietary advice should the nurse provide?

• A. Increase intake of caffeine.
• B. Maintain a consistent salt intake.
• C. Avoid dairy products.
• D. Increase intake of green leafy vegetables.

Correct answer: B

Rationale: The correct answer is B: Maintain a consistent salt intake. Patients prescribed lithium should maintain a consistent salt intake to help stabilize lithium levels. Fluctuations in salt intake can affect the levels of lithium in the body, potentially leading to toxicity or reduced effectiveness of the medication. It is important for patients to be consistent with their salt intake and to avoid sudden increases or decreases. Choices A, C, and D are incorrect. Increasing intake of caffeine is not recommended as it can interfere with the effects of lithium. Avoiding dairy products is not necessary unless there are specific intolerances or interactions with other medications. While green leafy vegetables are generally healthy, there is no specific recommendation to increase their intake in relation to lithium therapy.

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