Nursing Elites

1. The healthcare provider notes a blood pressure of 160/90 mm Hg in a patient taking a thiazide diuretic. The patient reports taking an herbal medication that a friend recommended. Which herbal product is likely, given this patient’s blood pressure?

• A. Ginkgo
• B. Hawthorn
• C. Licorice
• D. St. John’s wort

Correct answer: A

Rationale: The correct answer is A: Ginkgo. Increased blood pressure can result when ginkgo is used in combination with a thiazide diuretic. Option B (Hawthorn) is incorrect because hawthorn is more commonly associated with lowering blood pressure. Option C (Licorice) is incorrect because licorice can lead to sodium and water retention, potentially exacerbating hypertension. Option D (St. John’s wort) is incorrect as it is not typically associated with significant blood pressure effects.

2. A client with diabetes begins to cry and says, 'I just cannot stand the thought of having to give myself a shot every day.' Which of the following would be the best response by the nurse?

• A. If you do not give yourself your insulin shots, you will die.
• B. We can teach your daughter to give the shots so you will not have to do it.
• C. I can arrange to have a home care nurse give you the shots every day.
• D. What is it about giving yourself the insulin shots that bothers you?

Correct answer: D

Rationale: The correct response is option D because it is an open-ended question that allows the client to express their feelings and concerns. This approach facilitates a therapeutic communication process by encouraging the client to verbalize their thoughts, emotions, and fears related to giving themselves insulin shots. Option A is incorrect as it uses a fear-inducing statement that may not be helpful in addressing the client's emotional needs. Option B assumes involvement of a family member without exploring the client's feelings further. Option C offers a solution without addressing the client's underlying concerns and emotions, potentially overlooking essential aspects of client-centered care.

3. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

4. What is a priority intervention for a patient experiencing a thyroid storm?

• A. Administering antipyretics.
• B. Cooling the patient.
• C. Administering beta-blockers.
• D. Administering antithyroid medications.

Correct answer: D

Rationale: During a thyroid storm, the priority intervention is to administer antithyroid medications to reduce thyroid hormone levels quickly. These medications, such as propylthiouracil or methimazole, help inhibit the production of thyroid hormones. Administering antipyretics (choice A) may help reduce fever, but it does not address the underlying cause of the thyroid storm. Cooling the patient (choice B) may provide symptomatic relief but does not address the thyroid hormone dysregulation. Administering beta-blockers (choice C) can help manage symptoms like tachycardia and hypertension, but it does not target the root cause of the thyroid storm.

5. The nurse is planning care for an older adult client who experienced a cerebrovascular accident several weeks ago. The client has expressive aphasia and often becomes frustrated with the nursing staff. Which intervention should the nurse implement?

• A. Teach the client the use of basic sign language
• B. Speak slowly to the client
• C. Encourage the client's use of picture charts
• D. Ask the client simple questions

Correct answer: C

Rationale: Encouraging the client's use of picture charts is the most appropriate intervention for a client with expressive aphasia. Picture charts provide visual cues that can aid in communication and reduce frustration for the client. This intervention can help the client express their needs and thoughts effectively. Teaching sign language (Choice A) may be challenging and not as practical in this situation as it may not address the specific communication barriers caused by expressive aphasia. Speaking slowly (Choice B) may not fully address the communication difficulties associated with expressive aphasia. Asking simple questions (Choice D) may not be effective as the client may have difficulty understanding and responding due to the nature of expressive aphasia.

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