Nursing Elites

1. The healthcare provider is providing care to a client with a tracheostomy. Which action should the healthcare provider take to prevent tracheostomy complications?

• A. Use sterile technique when performing tracheostomy care.
• B. Suction the tracheostomy tube every hour.
• C. Keep the tracheostomy tube cuff inflated at all times.
• D. Change the tracheostomy ties daily.

Correct answer: A

Rationale: Using sterile technique when performing tracheostomy care is essential to prevent infections and other complications. Proper sterile technique helps reduce the risk of introducing harmful bacteria into the tracheostomy site, which can lead to infections and other serious issues. By maintaining a sterile environment during tracheostomy care, the healthcare provider can promote healing and prevent potential complications.

2. The healthcare provider is caring for a client with Guillain-Barré syndrome. Which assessment finding requires the healthcare provider's immediate action?

• A. Loss of deep tendon reflexes.
• B. Ascending weakness.
• C. New onset of confusion.
• D. Decreased vital capacity.

Correct answer: D

Rationale: Decreased vital capacity is the most critical assessment finding in a client with Guillain-Barré syndrome as it indicates respiratory compromise. This requires immediate intervention to ensure adequate ventilation and prevent respiratory failure, a common complication of this syndrome. Monitoring and maintaining respiratory function are vital in these clients to prevent complications such as respiratory distress, hypoxia, and respiratory failure. Loss of deep tendon reflexes and ascending weakness are typical manifestations of Guillain-Barré syndrome but do not require immediate action compared to compromised respiratory function. New onset of confusion may be a concern but is not as immediately life-threatening as decreased vital capacity.

3. A patient with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. What is the most important instruction the nurse should give?

• A. Report any vision changes immediately.
• B. Take the medication with milk.
• C. Avoid high-fat foods.
• D. Increase intake of green leafy vegetables.

Correct answer: A

Rationale: The correct instruction for a patient prescribed hydroxychloroquine, especially in the context of systemic lupus erythematosus (SLE), is to report any vision changes immediately. Hydroxychloroquine can potentially cause retinal damage, so prompt reporting and ophthalmologic evaluation are essential in preventing irreversible eye complications. Choices B, C, and D are incorrect because they do not address the significant adverse effect of hydroxychloroquine on vision. Taking the medication with milk, avoiding high-fat foods, or increasing intake of green leafy vegetables are not relevant to the primary concern of monitoring for visual changes.

4. A 70-year-old woman presents with fatigue, anorexia, and weight loss. She has noticed darkening of her skin, particularly in sun-exposed areas. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?

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

Correct answer: B

Rationale: The combination of symptoms such as fatigue, anorexia, weight loss, hyperpigmentation of the skin, along with hyponatremia, hyperkalemia, and low cortisol levels, points towards Addison's disease. This condition is characterized by adrenal insufficiency, leading to a deficiency in cortisol and aldosterone production.

5. An elderly client with congestive heart failure (CHF) is admitted to the hospital. Which laboratory test result should the nurse expect to find?

• A. Elevated serum sodium level.
• B. Decreased brain natriuretic peptide (BNP) level.
• C. Increased serum creatinine level.
• D. Elevated hemoglobin and hematocrit levels.

Correct answer: C

Rationale: In clients with congestive heart failure (CHF), impaired cardiac function can lead to decreased renal perfusion, resulting in elevated serum creatinine levels. Therefore, an increased serum creatinine level is a common laboratory finding in CHF clients, indicating possible renal impairment.

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