Nursing Elites

1. Which client is at greatest risk for developing delirium?

• A. An adult client who cannot sleep due to pain.
• B. An older client who attempted suicide 1 month ago.
• C. A young adult taking antipsychotic medications twice daily.
• D. A middle-aged woman using supplemental oxygen.

Correct answer: B

Rationale: The correct answer is B. Older adults who have attempted suicide are at higher risk for developing delirium, especially in the context of underlying mental health conditions. Choice A is incorrect as sleep disturbances due to pain may lead to discomfort but not necessarily delirium. Choice C is incorrect as taking antipsychotic medications, if managed well, does not inherently increase the risk of delirium. Choice D is incorrect as using supplemental oxygen alone does not significantly increase the risk of developing delirium.

2. Which information is a priority for the RN to reinforce to an older client after intravenous pyelography?

• A. Eat a light diet for the remainder of the day
• B. Rest for the next 24 hours as the preparation and the test are tiring
• C. Drink at least 1 8-ounce glass of fluid every waking hour for the next 2 days
• D. Measure the urine output for the next day and promptly notify the healthcare provider if it decreases

Correct answer: D

Rationale: After intravenous pyelography, it is crucial for the client to measure urine output in the next day to monitor for any potential complications, such as kidney issues. Promptly notifying the healthcare provider in case of decreased urine output is essential for timely intervention. While rest and hydration are important post-procedure, monitoring urine output takes precedence due to its direct correlation with potential complications.

3. A client is diagnosed with Meniere's disease. Which problem should the nurse identify as most important in the plan of care?

• A. Social isolation related to hearing loss
• B. Risk for injury related to vertigo
• C. Impaired verbal communication
• D. Impaired hearing related to ear disease

Correct answer: B

Rationale: Vertigo is the primary symptom of Meniere's disease and can lead to falls and other injuries. Ensuring safety and addressing the risk of injury is the nurse's top priority. While social isolation and impaired hearing are significant concerns associated with Meniere's disease, the immediate danger of falls due to vertigo takes precedence in the plan of care. Impaired verbal communication, although important, is not as urgent as preventing injuries caused by vertigo.

4. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative. What information should the nurse include in the client’s teaching plan?

• A. Pap smear is sufficient to detect ovarian cancer
• B. Surgery is unnecessary based on negative Pap smear
• C. Further evaluation involving surgery may be needed
• D. No further tests are needed

Correct answer: C

Rationale: A negative Pap smear does not rule out ovarian cancer, which often requires more comprehensive evaluation, including imaging studies or surgery. The client should be informed that the Pap smear primarily detects cervical cancer, not ovarian cancer. Therefore, further evaluation involving imaging studies or surgery may be necessary to determine the presence of ovarian cancer. Choice A is incorrect because a Pap smear is not sufficient to detect ovarian cancer. Choice B is incorrect because surgery may be necessary for further evaluation if ovarian cancer is suspected. Choice D is incorrect because further tests are needed to confirm or rule out ovarian cancer.

5. A client who has been prescribed multiple antihypertensive medications experiences syncope and has a blood pressure of 70/40. What is the rationale for the nurse to hold the next scheduled antihypertensive dose?

• A. Increased urinary clearance of the medications has produced diuresis, lowering the blood pressure.
• B. The antagonistic interaction of the medications has reduced their effectiveness.
• C. The synergistic effect of the medications has resulted in drug toxicity, causing hypotension.
• D. The additive effect of the medications has lowered the blood pressure too much.

Correct answer: D

Rationale: The additive effect of multiple antihypertensive medications can cause hypotension, leading to dangerously low blood pressure. In this scenario, the client experiencing syncope with a blood pressure of 70/40 indicates severe hypotension, likely due to the combined action of the antihypertensive medications. Holding the next scheduled dose is essential to prevent further lowering of blood pressure and potential complications. Choices A, B, and C provide inaccurate explanations and do not align with the client's presentation and the need to manage hypotension caused by the additive effect of the medications.

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