Nursing Elites

1. An older adult client with chronic emphysema is admitted with acute onset of weakness, palpitation, and vomiting. Which information is most important for the nurse to obtain during the initial interview?

• A. Medication compliance over the past few weeks.
• B. Recent sleep patterns and rest.
• C. Recent history of smoking.
• D. Activity level prior to symptom onset.

Correct answer: A

Rationale: The correct answer is A: Medication compliance over the past few weeks. In a client with chronic emphysema experiencing acute symptoms, it is crucial to assess medication compliance as it directly impacts symptom control and disease management. Ensuring the client has been adherent to their prescribed medications can provide insights into potential exacerbating factors or the need for adjustments in the treatment plan. Choices B, C, and D are less critical during the initial assessment compared to medication compliance. Recent sleep patterns and rest (choice B) may be relevant but are secondary to ensuring proper medication management. While smoking history (choice C) is important in chronic lung conditions, the immediate focus should be on the current status of medication use. Activity level prior to symptom onset (choice D) is also pertinent but not as crucial as confirming medication compliance to address the acute symptoms.

2. An adult male is brought to the emergency department following a motorcycle accident, presenting with periorbital bruising and bloody drainage from both ears. Which assessment finding warrants immediate intervention by the nurse?

• A. Rebound abdominal tenderness.
• B. Diminished bilateral breath sounds.
• C. Rib pain with deep inspiration.
• D. Nausea with projectile vomiting.

Correct answer: D

Rationale: In this scenario, the patient's presentation with periorbital bruising and bloody ear drainage suggests a basilar skull fracture. Projectile vomiting, as described in choice D, is concerning for increased intracranial pressure due to the skull fracture. This finding warrants immediate intervention to prevent further neurological compromise. Choices A, B, and C are not the priority in this situation. Rebound abdominal tenderness (choice A) is indicative of intra-abdominal injury but is not as urgent as managing potential intracranial issues. Diminished breath sounds (choice B) and rib pain with deep inspiration (choice C) may suggest underlying chest injuries, which need attention but are not as immediately life-threatening as increased intracranial pressure.

3. A client with hyperkalemia is receiving insulin and glucose. Which laboratory value should the nurse monitor closely?

• A. Monitor the client's blood glucose level.
• B. Monitor the client's sodium level.
• C. Monitor the client's calcium level.
• D. Monitor the client's potassium level.

Correct answer: D

Rationale: The correct answer is to monitor the client's potassium level. When administering insulin and glucose in hyperkalemia, the aim is to shift potassium from the bloodstream into the cells, lowering elevated levels. Therefore, monitoring potassium levels closely is essential to prevent hypokalemia or further complications. Monitoring blood glucose levels (Choice A) is important but not the priority in this scenario. Monitoring sodium (Choice B) and calcium levels (Choice C) is not directly related to the treatment of hyperkalemia with insulin and glucose.

4. What are the primary pathophysiological mechanisms responsible for ascites in liver failure?

• A. Decreased liver enzymes.
• B. Increased hydrostatic pressure in portal circulation.
• C. High bilirubin levels.
• D. Fluid shifts due to decreased serum proteins.

Correct answer: B

Rationale: The correct answer is B: Increased hydrostatic pressure in portal circulation. Ascites in liver failure is primarily caused by fluid shifts from the intravascular space to the interstitial space due to increased hydrostatic pressure in the portal circulation. Choice A is incorrect as ascites is not caused by decreased liver enzymes. Choice C is incorrect as high bilirubin levels are not the primary mechanism for ascites in liver failure. Choice D is incorrect as fluid shifts in ascites are due to decreased serum proteins, not increased serum proteins.

5. A client with hypothyroidism is experiencing severe lethargy and cold intolerance. What action should the nurse take?

• A. Increase the dose of levothyroxine.
• B. Administer a PRN dose of antipyretic medication.
• C. Provide a warm blanket and increase the room temperature.
• D. Increase the client's fluid intake to avoid dehydration.

Correct answer: A

Rationale: The correct answer is to increase the dose of levothyroxine. In hypothyroidism, the body does not produce enough thyroid hormone, leading to symptoms like lethargy and cold intolerance. Increasing the dose of levothyroxine, which is a synthetic thyroid hormone replacement, helps correct the deficiency and alleviates the symptoms. Choice B, administering antipyretic medication, is incorrect as antipyretics are used to reduce fever, not treat hypothyroidism symptoms. Choice C, providing a warm blanket and increasing room temperature, may provide temporary comfort but does not address the underlying hormonal deficiency. Choice D, increasing fluid intake, is important for overall health but does not directly address the symptoms of hypothyroidism.

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