Nursing Elites

1. In conducting a health assessment for a family with a history of diabetes, which family member should be prioritized for further evaluation and intervention?

• A. a 50-year-old mother with a history of hypertension
• B. a 45-year-old father who is overweight and has high cholesterol
• C. a 17-year-old daughter who is inactive
• D. a 12-year-old son who has a normal weight and is active

Correct answer: B

Rationale: The correct answer is the 45-year-old father who is overweight and has high cholesterol. He possesses multiple risk factors for diabetes, indicating a need for prioritized evaluation and intervention. The mother's hypertension, the daughter's inactivity, and the son's normal weight and activity level are important factors to consider but do not present as immediate red flags for diabetes risk compared to the father's combination of being overweight and having high cholesterol.

2. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?

• A. Abruptly stop the medication.
• B. Continue the medication at the same dose.
• C. Ask the healthcare provider about tapering the drug dose over the next week.
• D. Increase the dose of the medication.

Correct answer: C

Rationale: Gradually tapering the dose over one to two weeks should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.

3. The healthcare provider is caring for a client with hyperparathyroidism. Which laboratory result requires immediate intervention?

• A. Serum calcium of 11 mg/dL.
• B. Serum phosphorus of 3 mg/dL.
• C. Serum magnesium of 1.8 mg/dL.
• D. Serum albumin of 4 g/dL.

Correct answer: A

Rationale: A serum calcium level of 11 mg/dL indicates hypercalcemia, which can be a complication of hyperparathyroidism and requires immediate intervention. Hypercalcemia can lead to serious complications such as cardiac dysrhythmias, renal failure, and neurologic symptoms. Monitoring and managing serum calcium levels are crucial in clients with hyperparathyroidism. Serum phosphorus, magnesium, and albumin levels are important to assess in clients with hyperparathyroidism, but they do not require immediate intervention as hypercalcemia poses a more urgent risk.

4. The nurse is caring for a client with cirrhosis of the liver. Which laboratory result requires immediate intervention?

• A. Serum albumin of 3.5 g/dL.
• B. Prothrombin time (PT) of 12 seconds.
• C. Hemoglobin of 10 g/dL.
• D. Serum ammonia level of 180 mcg/dL.

Correct answer: D

Rationale: The correct answer is D, the serum ammonia level of 180 mcg/dL. An elevated serum ammonia level indicates hepatic dysfunction and can lead to hepatic encephalopathy, which is a medical emergency requiring immediate intervention. Options A, B, and C are within normal ranges or slightly abnormal values for clients with cirrhosis and do not pose an immediate threat. Serum albumin levels may indicate malnutrition, prothrombin time may reflect liver synthetic function, and hemoglobin levels can be affected by various factors but do not require immediate intervention in this scenario.

5. While assessing a client receiving a blood transfusion, which finding requires immediate intervention?

• A. Temperature of 100.4°F (38°C).
• B. Blood pressure of 110/70 mm Hg.
• C. Heart rate of 90 beats per minute.
• D. Complaints of feeling cold.

Correct answer: C

Rationale: A heart rate of 90 beats per minute requires immediate intervention when assessing a client receiving a blood transfusion. This finding can indicate a potential transfusion reaction, such as a hemolytic reaction or fluid overload, which requires prompt evaluation and management to prevent serious complications. While a temperature of 100.4°F (38°C) may indicate a mild fever, it is not typically an immediate concern during a blood transfusion. A blood pressure of 110/70 mm Hg is within the normal range and does not necessitate immediate intervention. Complaints of feeling cold can be addressed but do not indicate an urgent need for intervention compared to the critical nature of a potential transfusion reaction indicated by an elevated heart rate.

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