Nursing Elites

1. The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid retraction, and a staring expression. These findings are consistent with which disorder?

• A. Graves' disease.
• B. Cushing's syndrome.
• C. Addison's disease.
• D. Hypothyroidism.

Correct answer: A

Rationale: The correct answer is A, Graves' disease. The symptoms described in the client are classic manifestations of hyperthyroidism, which is commonly caused by Graves' disease, an autoimmune condition affecting the thyroid. Weight loss, racing heart rate, difficulty sleeping, moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are all indicative of hyperthyroidism. Choice B, Cushing's syndrome, is characterized by weight gain, hypertension, and a rounded face due to excess cortisol. Choice C, Addison's disease, presents with symptoms such as weight loss, fatigue, and hyperpigmentation due to adrenal insufficiency. Choice D, hypothyroidism, typically features symptoms opposite to those described in the client, such as weight gain, bradycardia, and dry skin.

2. A client with a history of coronary artery disease is admitted with chest pain. Which finding requires immediate intervention?

• A. Heart rate of 90 beats per minute.
• B. Blood pressure of 130/80 mm Hg.
• C. Respiratory rate of 20 breaths per minute.
• D. Chest pain radiating to the left arm.

Correct answer: D

Rationale: The correct answer is D. Chest pain radiating to the left arm can be a sign of myocardial infarction (heart attack) and requires immediate intervention. This symptom is known as a classic presentation of a heart attack and warrants urgent medical attention to prevent further cardiac damage. Choices A, B, and C are not directly indicative of an acute cardiac event and may not require immediate intervention in this scenario. While heart rate, blood pressure, and respiratory rate are important vital signs to monitor, they do not specifically indicate the urgency associated with chest pain radiating to the left arm in a patient with a history of coronary artery disease.

3. The healthcare provider is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding requires immediate intervention?

• A. Oxygen saturation of 88%.
• B. Use of accessory muscles for breathing.
• C. Respiratory rate of 26 breaths per minute.
• D. Barrel-shaped chest.

Correct answer: C

Rationale: A respiratory rate of 26 breaths per minute is an abnormal finding and indicates that the client is experiencing respiratory distress, requiring immediate intervention. This rapid respiratory rate can signify inadequate oxygenation and ventilation. Oxygen saturation of 88% is low but not as immediately concerning as a high respiratory rate, which indicates the body is compensating for respiratory distress. The use of accessory muscles for breathing and a barrel-shaped chest are typical findings in clients with COPD but do not indicate an immediate need for intervention as they are more chronic in nature and may be seen in stable COPD patients.

4. A client with hypertension is being seen in a community clinic. The nurse notes that the client has not been taking their prescribed medication regularly. What is the most appropriate initial intervention?

• A. Educate the client on the importance of medication adherence
• B. Explore the reasons for non-adherence with the client
• C. Refer the client to a hypertension specialist
• D. Adjust the client's medication regimen

Correct answer: B

Rationale: The most appropriate initial intervention when a client is not adhering to prescribed medication is to explore the reasons for non-adherence with the client. Understanding the client's perspective can help identify barriers to adherence, such as side effects, cost, forgetfulness, or misunderstanding of the treatment. By addressing these reasons, the nurse can work collaboratively with the client to develop strategies to improve medication compliance. Educating the client on the importance of adherence (Choice A) may be necessary but should come after exploring the reasons for non-adherence. Referring the client to a hypertension specialist (Choice C) or adjusting the medication regimen (Choice D) should be considered after addressing the underlying reasons for non-adherence.

5. A client with type 2 diabetes mellitus is admitted with hyperosmolar hyperglycemic state (HHS). Which laboratory result requires immediate intervention?

• A. Serum osmolality of 320 mOsm/kg.
• B. Serum glucose of 600 mg/dL.
• C. Serum potassium of 4.5 mEq/L.
• D. Serum sodium of 140 mEq/L.

Correct answer: B

Rationale: A serum glucose level of 600 mg/dL is extremely high in a client with hyperosmolar hyperglycemic state (HHS) and poses a significant risk of serious complications such as dehydration, coma, and electrolyte imbalances. Rapid intervention is crucial to normalize the glucose level and prevent further deterioration. Serum osmolality of 320 mOsm/kg, serum potassium of 4.5 mEq/L, and serum sodium of 140 mEq/L, while important to monitor in HHS, do not represent an immediate life-threatening condition that requires urgent intervention compared to the critically high glucose level.

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