Nursing Elites

1. The nurse has completed the admission assessment of a client and has determined that the client's body mass index (BMI) is 33.5 kg/m2. What health promotion advice should the nurse provide to the client?

• A. It would be very helpful if you could integrate more physical activity into your routine.
• B. You're considered to be overweight, so you should be diligent about maintaining a healthy diet.
• C. You might want to consider some of the surgical options that have been developed for treating obesity.
• D. With your permission, I'd like you to refer to a support group for individuals who live with severe obesity.

Correct answer: A

Rationale: Increasing physical activity is a key component of managing BMI and overall health.

2. A patient with bipolar disorder is prescribed valproic acid. What is an important side effect for the nurse to monitor?

• A. Hypertension
• B. Liver toxicity
• C. Hyperglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Liver toxicity. Valproic acid is known to potentially cause liver toxicity. Monitoring liver function tests regularly in patients taking valproic acid is crucial to detect any signs of liver damage early and prevent serious complications.

3. A patient with severe pain is prescribed morphine sulfate. What is the most important side effect for the nurse to monitor?

• A. Diarrhea
• B. Hypertension
• C. Respiratory depression
• D. Increased urine output

Correct answer: C

Rationale: When a patient is prescribed morphine sulfate, the most critical side effect for the nurse to monitor is respiratory depression. Morphine can suppress the respiratory drive, leading to inadequate ventilation and potentially life-threatening consequences. Monitoring the patient's respiratory status closely is essential to promptly identify and manage any signs of respiratory depression.

4. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

5. A patient with tuberculosis is started on rifampin. What advice should the nurse provide?

• A. Limit intake of green leafy vegetables.
• B. Expect orange-red discoloration of body fluids.
• C. Avoid exposure to sunlight.
• D. Take the medication with antacids.

Correct answer: B

Rationale: The correct advice for a patient starting rifampin is to expect orange-red discoloration of body fluids. Rifampin can cause harmless orange-red discoloration of body fluids, which may include urine, sweat, saliva, and tears. It is important for the patient to be aware of this side effect as it can stain clothing and contact lenses. Limiting the intake of green leafy vegetables is not necessary with rifampin. Avoiding exposure to sunlight is more commonly associated with other medications like tetracyclines, not rifampin. Taking rifampin with antacids is not recommended as antacids can reduce the absorption of rifampin, decreasing its effectiveness in treating tuberculosis.

Similar Questions