Nursing Elites

1. The healthcare provider is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which intervention is most important?

• A. Restrict fluids to 1,000 mL per day.
• B. Administer a vasopressin antagonist.
• C. Monitor intake and output.
• D. Encourage a high-sodium diet.

Correct answer: B

Rationale: Administering a vasopressin antagonist is the most critical intervention for a client with SIADH. SIADH is characterized by excessive release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. A vasopressin antagonist helps manage the symptoms by blocking the effects of ADH, promoting water excretion, and restoring electrolyte balance. Restricting fluids (choice A) may exacerbate hyponatremia, monitoring intake and output (choice C) is important but not the most critical intervention, and encouraging a high-sodium diet (choice D) is contraindicated in SIADH due to the risk of worsening hyponatremia.

2. An 80-year-old client is given morphine sulfate for postoperative pain. Which concomitant medication should the nurse question that poses a potential development of urinary retention in this geriatric client?

• A. Nonsteroidal anti-inflammatory agents.
• B. Antihistamines.
• C. Tricyclic antidepressants.
• D. Antibiotics.

Correct answer: C

Rationale: The correct answer is C: Tricyclic antidepressants. Drugs with anticholinergic properties, such as tricyclic antidepressants, can exacerbate urinary retention associated with opioids in older clients. Nonsteroidal anti-inflammatory agents (Choice A) do not typically cause urinary retention. Antihistamines (Choice B) may cause urinary retention but are not the primary concern in this scenario. Antibiotics (Choice D) are not associated with an increased risk of urinary retention compared to tricyclic antidepressants.

3. The home health nurse visits a young male client with AIDS who has Kaposi's sarcoma and peripheral neuropathies. His parents, who are the caregivers, tell the nurse that their son sleeps most of the time. The nurse assesses that the client is semi-conscious with stable vital signs, cries out in pain when turned or moved, has a Duragesic pain patch in place, and skin lesions that are closed and dried. Which intervention should the nurse implement?

• A. remove the Duragesic patch as directed by the prescription
• B. give the client a complete bed bath to further assess the client's condition
• C. discuss end-of-life decisions with the client's parents
• D. call for ambulance transportation to the hospital immediately

Correct answer: C

Rationale: In this scenario, the client with AIDS is showing signs of being in a critical condition - semi-conscious, in pain, and with stable vital signs. The appropriate intervention for the nurse to implement is to discuss end-of-life decisions with the client's parents. Given the client's symptoms, the presence of a pain patch, and the closed and dried skin lesions, it is essential to address end-of-life care planning. Removing the Duragesic patch without proper authorization can lead to inadequate pain management and should not be done without consulting the healthcare provider. Giving a complete bed bath is not the priority in this situation as it does not address the immediate needs of the client. Calling for ambulance transportation to the hospital immediately may not be necessary if the client is stable; instead, the focus should be on providing appropriate support and having critical discussions about the client's care preferences.

4. 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.

5. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which additional assessment should the nurse make?

• A. How long has the client been taking the medication?
• B. Assess the client's dietary habits.
• C. Check for signs of infection.
• D. Evaluate the client's sleep pattern.

Correct answer: A

Rationale: The correct answer is A. When a client reports drowsiness while taking clonidine, the nurse should assess how long the client has been taking the medication. Drowsiness is a common side effect that can occur in the early weeks of treatment with clonidine. By understanding the duration of medication use, the nurse can determine if the drowsiness is a temporary effect that may decrease over time. Choices B, C, and D are incorrect because assessing the client's dietary habits, checking for signs of infection, or evaluating the client's sleep pattern would not directly address the drowsiness associated with clonidine use.

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