Nursing Elites

1. Which of the following is a characteristic symptom of hypothyroidism?

• A. Fatigue.
• B. Weight gain.
• C. Cold intolerance.
• D. Heat intolerance.

Correct answer: C

Rationale: The correct answer is 'Cold intolerance.' Hypothyroidism is associated with a decreased metabolic rate, leading to a decreased ability to regulate body temperature and a feeling of being cold. Fatigue (Choice A) and weight gain (Choice B) are also common symptoms of hypothyroidism due to the overall slowing down of bodily functions. Heat intolerance (Choice D) is more commonly associated with hyperthyroidism, where the body's metabolism is overactive, leading to increased heat production.

2. A middle-aged adult with a family history of CAD has the following: total cholesterol 198 (11 mmol/L); LDL cholesterol 120 (6.7 mmol/L); HDL cholesterol 58 (3.2 mmol/L); triglycerides 148 (8.2 mmol/L); blood sugar 102 (5.7 mmol/L); and C-reactive protein (CRP) 4.2. The health care provider prescribes a statin medication and aspirin. The client asks the nurse why these medications are needed. Which is the best response by the nurse?

• A. The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a low-fat diet.
• B. The triglycerides are elevated and will not return to normal without these medications.
• C. The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications prescribed.
• D. These medications will reduce the risk of type 2 diabetes.

Correct answer: C

Rationale: CRP is a marker of inflammation, which is elevated in cardiovascular disease. Statins and aspirin help lower CRP and reduce the risk of heart attacks and strokes.

3. After an endotracheal tube is placed in a client who experienced sudden onset of respiratory distress, what should the nurse do?

• A. Secure the tube in place with tape
• B. Order a chest x-ray for the client
• C. Document the depth of tube insertion
• D. Auscultate both lungs for breath sounds

Correct answer: D

Rationale: After endotracheal tube insertion, the nurse should auscultate both lungs for the presence of breath sounds. This step helps confirm proper tube placement and adequate ventilation. Auscultation of breath sounds is crucial to ensure that the tube is correctly positioned in the trachea and not in the esophagus. While securing the tube with tape is important, it is not the immediate priority after insertion. Ordering a chest x-ray may be necessary but is not the first action to take immediately post-intubation. Documenting the depth of tube insertion is important but ensuring proper ventilation through auscultation takes precedence.

4. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39°C. What is the nurse’s next action?

• A. Administer the antibiotic as ordered.
• B. Contact the provider to request another culture.
• C. Discuss the need to add a second antibiotic with the provider.
• D. Review the sensitivity results from the patient’s culture.

Correct answer: D

Rationale: In this scenario, the nurse is observing signs of a possible lack of response to the current antibiotic therapy, such as increased erythema, swelling, and persistent high fever. The next appropriate action for the nurse is to review the sensitivity results from the patient’s culture. This step is crucial to determine if the current antibiotic is effective against the causative organism. If the sensitivity results indicate resistance to the current antibiotic, the antibiotic should be discontinued, and the provider should be notified for a change in therapy. Contacting the provider to request another culture is not the immediate priority, as the existing culture results need to be reviewed first. Adding a second antibiotic should only be considered after confirming the sensitivity results, as unnecessary antibiotic use can lead to antimicrobial resistance.

5. A nurse is preparing for intershift report when a nurse’s aide pulls an emergency call light in a client’s room. Upon answering the light, the nurse finds a client who returned from surgery earlier in the day experiencing tachycardia and tachypnea. The client’s blood pressure is 88/60 mm Hg. Which action should the nurse take first?

• A. Calling the physician
• B. Checking the hourly urine output
• C. Checking the IV site for infiltration
• D. Placing the client in a modified Trendelenburg position

Correct answer: D

Rationale: The client is exhibiting signs of shock, indicated by tachycardia, tachypnea, and hypotension. Placing the client in a modified Trendelenburg position is the initial action to improve venous return, cardiac output, and subsequently increase blood pressure. This position helps redistribute blood flow to vital organs. Calling the physician should follow once immediate intervention has been initiated. Checking the hourly urine output and IV site are important assessments but are secondary to addressing the client's hemodynamic instability and potential for shock.

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