Nursing Elites

1. When attempting to establish risk reduction strategies in a community, the nurse notes that regional studies indicate a high number of persons with growth stunting and irreversible mental deficiencies caused by hypothyroidism (cretinism). The nurse should seek funding to implement which screening measure?

• A. T3 levels in school-aged children
• B. T4 levels in newborns
• C. TSH levels in women over 45
• D. Iodine levels in all persons over 60

Correct answer: B

Rationale: Screening T4 levels in newborns is crucial as it helps in the early detection of hypothyroidism, which can prevent conditions like cretinism. Checking T3 levels in school-aged children (Choice A) is not the most appropriate measure for early detection of hypothyroidism in newborns. Monitoring TSH levels in women over 45 (Choice C) is not directly related to detecting hypothyroidism in newborns. Additionally, monitoring iodine levels in all persons over 60 (Choice D) is not specifically aimed at early detection of hypothyroidism in newborns, which is crucial to prevent cretinism.

2. A male client who fell into the lake while fishing and was submerged for about 3 min was successfully resuscitated by his friends. He was brought to the Emergency Department for evaluation and was admitted for a 24-hour uneventful hospital stay. What follow-up instruction should the nurse give?

• A. Avoid smoke-filled environments
• B. Seek medical care promptly if a fever develops
• C. Increase oral fluids if a cough becomes productive
• D. Schedule frequent rest periods

Correct answer: B

Rationale: After being submerged in water, the client should be instructed to seek medical care promptly if a fever develops since complications may arise later. Choices A, C, and D are not directly related to the potential complications from submersion in water and are therefore incorrect. Avoiding smoke-filled environments, increasing oral fluids for a productive cough, and scheduling frequent rest periods are not the priority concerns in this scenario.

3. When lactulose (Cephulac) 30 ml QID is prescribed for a male client with advanced cirrhosis, and he complains that it causes diarrhea, what action should the nurse take in response to the client’s statement?

• A. Explain that diarrhea is expected, but the drug reduces ammonia levels
• B. Document that the client is non-compliant with his treatment plan
• C. Tell the client to be concerned about more significant side effects of this drug
• D. Obtain a prescription for loperamide (Imodium) 4mg PO PRN diarrhea

Correct answer: A

Rationale: The correct answer is A. Diarrhea is an expected side effect of lactulose when used to reduce ammonia levels in cirrhosis. It helps in decreasing the absorption of ammonia in the colon, thereby reducing its levels in the blood. Option B is incorrect because it is essential for the nurse to educate the client about the expected side effects of the medication rather than assuming non-compliance. Option C is incorrect as it instills unnecessary fear in the client by suggesting more significant side effects without addressing the current concern. Option D is incorrect as loperamide should not be given automatically for diarrhea caused by lactulose, as the diarrhea is a therapeutic effect of the medication in this context.

4. What action should the nurse implement for a female client with cancer who has a good appetite but experiences nausea whenever she smells food cooking?

• A. Encourage family members to cook meals outdoors and bring the cooked food inside
• B. Advise the client to replace cooked foods with a variety of different nutritional supplements
• C. Assess the client’s mucus membranes and report the findings to the healthcare provider
• D. Instruct the client to take an antiemetic before every meal to prevent excessive vomiting

Correct answer: A

Rationale: The correct action for the nurse to implement is to encourage family members to cook meals outdoors and bring the cooked food inside. This strategy can help reduce the smell of cooking food and potentially alleviate the client's nausea triggered by food smells. Assessing the client's mucus membranes (choice C) is not directly related to the client's symptom of nausea triggered by food smells. Instructing the client to take an antiemetic before every meal (choice D) may not address the root cause of the issue, which is the smell of cooking food. Advising the client to replace cooked foods with nutritional supplements (choice B) does not address the immediate problem of food odors triggering nausea.

5. In the Emergency Department, a female client discloses that she was raped last night. Which question is most important for the nurse to ask?

• A. Does she know the person who raped her?
• B. Has she taken a bath since the rape occurred?
• C. Is the place where she lives a safe place?
• D. Did she report the rape to the police department?

Correct answer: A

Rationale: The most important question for the nurse to ask in this situation is whether the client knows the person who raped her. This question is crucial for assessing additional safety concerns, providing appropriate support, and determining the need for forensic evidence collection. Choices B, C, and D are not as critical in the immediate assessment and response to a rape victim. Asking about bathing, the safety of her home, or reporting to the police may be important but are secondary to identifying the perpetrator for safety and legal reasons.

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