Nursing Elites

1. When is a depressed client at highest risk for attempting suicide?

• A. Immediately after admission, during one-to-one observation
• B. 7 to 14 days after initiation of antidepressant medication and psychotherapy
• C. Following an angry outburst with family
• D. When the client is removed from the security room

Correct answer: B

Rationale: Depressed clients are at the highest risk of attempting suicide 7 to 14 days after starting antidepressant medication and psychotherapy. During this time, they may start to regain energy but still feel hopeless, which can increase the risk of suicidal ideation and behavior. Choices A, C, and D are incorrect because immediate post-admission, after an angry outburst with family, or when removed from a security room are not specific periods known to be associated with the highest risk of suicide in depressed clients.

2. The caregiver is assessing an 8-month-old child with atonic cerebral palsy. Which statement from the caregiver supports the presence of this problem?

• A. When I place my finger in the left hand, the baby does not respond with a grasp.
• B. My baby does not seem to track objects when I move toys in front of their face.
• C. When it thundered loudly last night, the baby did not even startle.
• D. When I place the baby in a supine position, that's how I find the baby.

Correct answer: D

Rationale: The statement 'When I place the baby in a supine position, that's how I find the baby' supports the presence of atonic cerebral palsy. In this type of cerebral palsy, the child may have poor muscle tone, making it difficult for them to roll from a back-lying position. This inability to roll indicates a lack of muscle tone, which is a characteristic feature of atonic cerebral palsy. Choices A, B, and C do not directly relate to the muscle tone issues typical of atonic cerebral palsy. Choice A focuses on a lack of grasp response, which may suggest motor issues but not specifically atonic cerebral palsy. Choice B refers to visual tracking, and choice C is about the startle reflex, neither of which are defining characteristics of atonic cerebral palsy.

3. During a change-of-shift report at a long-term care facility, a nurse discusses an older adult client with shingles with an oncoming nurse. What information should the nurse include in the report?

• A. The location of the client's breakfast.
• B. The schedule for administering routine vital signs.
• C. The specific transmission-based precautions in place.
• D. The type of transmission-based precautions in place.

Correct answer: D

Rationale: The correct answer is to include the type of transmission-based precautions in the report. This information is crucial for infection control when caring for a client with shingles, as it helps prevent the spread of the virus to other clients and healthcare workers. Choices A, B, and C are not directly related to managing a client with shingles. Option A about the location of breakfast is irrelevant to the client's condition. Option B about vital sign measurements, though important, is not the priority when discussing a client with shingles. Option C mentions 'specific times the client had visitors,' which is not as crucial as knowing the specific precautions in place to prevent transmission of the virus.

4. Before starting an intensive exercise program, what instruction is most important for the nurse to provide to the client?

• A. Be sure to have a complete physical examination before beginning your planned exercise program.
• B. Be careful that the exercise program doesn't simply add to your stress level, making you want to eat more.
• C. Increased exercise helps to reduce stress, so you may not need to spend money on a stress management class.
• D. Make sure to monitor your weight loss regularly to provide a sense of accomplishment and motivation.

Correct answer: A

Rationale: Before starting an intensive exercise program, it is crucial for the client to have a complete physical examination. This examination ensures that the client is physically fit to engage in such activities and helps in identifying any underlying health issues that could be exacerbated by the exercise regimen. Choice B is incorrect because it focuses on stress levels related to eating habits rather than the importance of a physical examination for safety. Choice C is incorrect as exercise and stress management classes can complement each other rather than being mutually exclusive. Choice D is incorrect as monitoring weight loss, while important, is not as critical as ensuring the client's physical readiness for the exercise program.

5. A client with a history of atrial fibrillation is taking digoxin (Lanoxin). Which finding should the healthcare provider be notified of immediately?

• A. Heart rate of 52 beats per minute
• B. Blood pressure of 110/70 mmHg
• C. Blood glucose level of 180 mg/dL
• D. Potassium level of 4.0 mEq/L

Correct answer: A

Rationale: A heart rate of 52 beats per minute is a critical finding in a client taking digoxin, as it may indicate digoxin toxicity. Digoxin can cause bradycardia as a side effect, and a heart rate of 52 bpm warrants immediate attention to prevent adverse outcomes. Monitoring and reporting changes in heart rate are crucial in clients on digoxin therapy to prevent serious complications. The other vital signs and laboratory values provided are within normal ranges or not directly associated with digoxin toxicity in this scenario, making them lower priority for immediate reporting.

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