Nursing Elites

1. The healthcare provider prescribes naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, 'The pills don't seem to be working. They are not helping the pain at all.' Which factor should influence the nurse's response?

• A. Noncompliance is probably affecting optimal medication effectiveness.
• B. Drug dosage is inadequate and needs to be increased to three times a day.
• C. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream.
• D. NSAID response is variable, and trying another NSAID may be more effective.

Correct answer: D

Rationale: Different NSAIDs work differently in individuals. If a patient is not experiencing relief with one NSAID, switching to a different one may provide better pain management. This variability in response is common among NSAIDs due to individual differences in drug metabolism and efficacy.

2. A client with type 1 diabetes mellitus is admitted with hyperglycemia. Which laboratory result requires the most immediate intervention?

• A. Serum glucose of 350 mg/dL.
• B. Serum potassium of 2.8 mEq/L.
• C. Serum sodium of 136 mEq/L.
• D. Serum bicarbonate of 20 mEq/L.

Correct answer: B

Rationale: A serum potassium level of 2.8 mEq/L is critically low and can cause cardiac arrhythmias, requiring immediate intervention. Hypokalemia is a life-threatening condition that needs prompt correction to prevent serious complications. High serum glucose levels (choice A) are a concern in diabetes but do not pose an immediate life-threatening risk compared to severe hypokalemia. Serum sodium (choice C) and serum bicarbonate levels (choice D) are within normal ranges and do not require immediate intervention.

3. The nurse is caring for four clients: Client A, who has emphysema and an oxygen saturation of 94%; Client B, with a postoperative hemoglobin of 8.7 g/dL; Client C, newly admitted with a potassium level of 3.8 mEq/L; and Client D, scheduled for an appendectomy with a white blood cell count of 15,000/mm3. What intervention should the nurse implement?

• A. Increase Client A's oxygen to 4 liters per minute via nasal cannula.
• B. Determine if Client B has two units of packed cells available in the blood bank.
• C. Ask the dietitian to add a banana to Client C's breakfast tray.
• D. Inform Client D that surgery is likely to be delayed until the infection is treated.

Correct answer: D

Rationale: A high white blood cell count, as seen in Client D, indicates infection, which may require postponing surgery to treat the infection adequately. It is crucial to address the underlying infection before proceeding with the appendectomy to prevent complications and ensure a successful surgical outcome.

4. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?

• A. Administer acetaminophen (Tylenol).
• B. Apply lotion to the skin.
• C. Encourage a high-protein diet.
• D. Provide a warm bath.

Correct answer: B

Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.

5. After a client with ascites due to liver cirrhosis undergoes a paracentesis, what should the nurse do post-procedure?

• A. Encourage the client to drink plenty of fluids
• B. Monitor the client's blood pressure and heart rate
• C. Position the client flat on their back
• D. Administer a dose of furosemide

Correct answer: B

Rationale: Post-paracentesis, monitoring the client's blood pressure and heart rate is crucial as it helps in early detection of potential complications such as hypotension or bleeding. This close observation enables timely intervention and ensures the client's safety.

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