Nursing Elites

1. The nurse assesses a client who is newly diagnosed with hyperthyroidism and observes that the client's eyeballs are protuberant, causing a wide-eyed appearance and eye discomfort. Based on this finding, which action should the nurse include in the client's plan of care?

• A. Assess for signs of increased intracranial pressure
• B. Prepare to administer intravenous levothyroxine
• C. Review the client's serum electrolyte values
• D. Obtain a prescription for artificial tear drops

Correct answer: D

Rationale: In hyperthyroidism, eye discomfort due to protuberant eyeballs (exophthalmos) can be alleviated by using artificial tear drops. These drops help prevent complications associated with dry eyes and promote comfort. Assessing for signs of increased intracranial pressure (Choice A) is not directly related to the client's eye discomfort from hyperthyroidism. Administering intravenous levothyroxine (Choice B) is not the appropriate intervention for managing eye discomfort in hyperthyroidism. Reviewing serum electrolyte values (Choice C) is important in hyperthyroidism but is not directly addressing the client's current eye discomfort and protuberant eyeballs.

2. A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?

• A. Lymph node involvement is not significant.
• B. Small tumors are aggressive and indicate poor prognosis.
• C. The tumor's estrogen receptor guides treatment options.
• D. Stage I indicates metastasis.

Correct answer: C

Rationale: Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which is one of the most important prognostic factors in early-stage breast cancer.

3. The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8°F (37.6°C). What is the most appropriate action by the nurse?

• A. Administer fluids to increase blood pressure.
• B. Check the white blood cell count.
• C. Monitor the client’s temperature.
• D. Connect the client to an electrocardiographic (ECG) monitor.

Correct answer: C

Rationale: After hemodialysis, it is crucial to monitor the client's temperature because the dialysate is warmed to increase diffusion and prevent hypothermia. The client's temperature might reflect the temperature of the dialysate. There is no need to administer fluids to increase blood pressure as the vital signs are within normal limits. Checking the white blood cell count or connecting the client to an ECG monitor is not necessary based on the information provided.

4. The patient will begin taking doxycycline to treat an infection. When should the nurse plan to give this medication?

• A. 1 hour before or 2 hours after a meal.
• B. with an antacid to minimize GI irritation.
• C. with food to improve absorption.
• D. with small sips of water.

Correct answer: C

Rationale: Doxycycline is a lipid-soluble tetracycline that is better absorbed when taken with milk products and food. Taking doxycycline with food helps improve its absorption. It should not be taken on an empty stomach, as this can decrease its effectiveness. Antacids can interfere with the absorption of tetracyclines, so they should not be taken together. While it is important to stay hydrated when taking medications, small sips of water are not specifically recommended for doxycycline administration.

5. The healthcare provider is assessing a client undergoing peritoneal dialysis. Which of the following findings should be reported immediately to the physician?

• A. Clear dialysate outflow.
• B. Clear dialysate inflow.
• C. Cloudy dialysate outflow.
• D. Increased blood pressure.

Correct answer: C

Rationale: Cloudy dialysate outflow should be reported immediately to the physician as it is a concerning sign of peritonitis, a severe infection of the peritoneum. Peritonitis is a serious complication of peritoneal dialysis that requires prompt medical intervention to prevent further complications. Clear dialysate outflow and inflow are normal findings in peritoneal dialysis and do not indicate an immediate need for intervention. Increased blood pressure, while important to monitor, is not directly related to peritoneal dialysis and would not be the priority over the potentially life-threatening complication of peritonitis.

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