Nursing Elites

1. During a home visit to an elderly client with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, 'She sleeps most of the day and is up most of the night. I can't get a decent night's sleep anymore.' Which suggestions should the nurse make to the daughter?

• A. Ask the client's physician for a strong sleep medicine
• B. Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime
• C. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day
• D. Promote relaxation before bedtime with a warm bath or relaxing music

Correct answer: B

Rationale: The correct answer is to establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. By creating a structured daily schedule, the client's natural sleep-wake cycle can be regulated, helping to address the issue of daytime sleeping and nighttime wakefulness. Option A, asking for a strong sleep medicine, may not address the underlying cause and can have potential side effects in the elderly. Option C, engaging in exercises when drowsy, may not be suitable for someone with dementia and could disrupt sleep patterns further. Option D, promoting relaxation before bedtime, is helpful but may not be sufficient to address the client's significant sleep issue.

2. A nurse is caring for a client who has coronary artery disease (CAD) and is receiving aspirin therapy. Which of the following findings should the nurse report to the provider?

• A. History of gastrointestinal bleeding
• B. Prothrombin time of 12 seconds
• C. Platelet count of 180,000/mm³
• D. Creatinine level of 1.0 mg/dL

Correct answer: A

Rationale: The correct answer is A: History of gastrointestinal bleeding. Aspirin therapy is contraindicated in clients with a history of gastrointestinal bleeding because aspirin can further increase the risk of bleeding. Option B, prothrombin time of 12 seconds, is within the normal range and does not indicate a concern related to aspirin therapy. Option C, platelet count of 180,000/mm³, is also within the normal range and does not suggest a need for reporting to the provider in the context of aspirin therapy. Option D, creatinine level of 1.0 mg/dL, is within the normal range and is not directly related to aspirin therapy in this scenario.

3. How should a healthcare professional assess a patient with potential pneumonia?

• A. Assess lung sounds and monitor oxygen saturation
• B. Monitor for fever and sputum production
• C. Auscultate heart sounds and check for cyanosis
• D. Monitor for chest pain and administer oxygen

Correct answer: A

Rationale: Correctly assessing a patient with potential pneumonia involves listening to lung sounds and monitoring oxygen saturation. Lung sounds can reveal abnormal breath sounds associated with pneumonia, such as crackles or diminished breath sounds. Oxygen saturation monitoring helps in detecting respiratory distress, a common complication of pneumonia. Monitoring for fever and sputum production (Choice B) is important but not as specific as assessing lung sounds and oxygen saturation. Auscultating heart sounds and checking for cyanosis (Choice C) are not primary assessments for pneumonia. Monitoring for chest pain and administering oxygen (Choice D) are relevant interventions but do not address the initial assessment of pneumonia.

4. What are the key interventions in managing a patient with diabetic ketoacidosis (DKA)?

• A. Administer insulin and fluids
• B. Administer oral hypoglycemics
• C. Administer glucagon
• D. Administer insulin and monitor blood glucose

Correct answer: A

Rationale: The correct intervention in managing a patient with diabetic ketoacidosis (DKA) is to administer insulin and fluids. Insulin is crucial to correct hyperglycemia, while fluids are important to address dehydration. Administering oral hypoglycemics (Choice B) is not appropriate in the management of DKA as the patient may not be able to absorb oral medications due to gastrointestinal issues. Glucagon (Choice C) is not indicated in the treatment of DKA. Although monitoring blood glucose (Choice D) is important, it is not the sole key intervention for managing DKA; administering insulin and fluids are the primary interventions.

5. Which dietary restriction should be taught to a client with chronic kidney disease?

• A. Increase potassium-rich foods
• B. Limit phosphorus and potassium intake
• C. Encourage increased protein intake
• D. Increase fluid intake

Correct answer: B

Rationale: The correct answer is B: Limit phosphorus and potassium intake. In chronic kidney disease, the kidneys are unable to effectively filter these minerals from the blood, leading to their accumulation and potential complications. Restricting phosphorus and potassium intake is crucial in managing the progression of the disease. Choice A is incorrect as increasing potassium-rich foods can worsen the condition. Choice C is also incorrect as excessive protein intake can put more strain on the kidneys. Choice D is not the priority; rather, fluid intake should be monitored based on individual needs and stage of kidney disease.

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