Nursing Elites

1. Which statement by the client indicates an understanding of the dietary modifications required with Cushing syndrome?

• A. I should increase my intake of foods high in calcium.
• B. I should avoid foods with high sodium content.
• C. I need to decrease my intake of vitamin D.
• D. I should consume more potassium-rich foods.

Correct answer: B

Rationale: The correct answer is B: 'I should avoid foods with high sodium content.' Clients with Cushing syndrome need to limit their sodium intake to help reduce fluid retention and manage hypertension, which are common complications of the syndrome. Increasing calcium intake (choice A) is not specifically indicated for Cushing syndrome. Decreasing vitamin D intake (choice C) is not a typical dietary modification for this condition. Consuming more potassium-rich foods (choice D) is not a primary focus of dietary modifications for Cushing syndrome.

2. At 0600 while admitting a woman for a scheduled repeat cesarean section (C-Section), the client tells the nurse that she drank a cup of coffee at 0400 because she wanted to avoid getting a headache. Which action should the nurse take first?

• A. Ensure preoperative lab results are available
• B. Start prescribed IV with lactated Ringer's
• C. Inform the anesthesia care provider
• D. Contact the client's obstetrician

Correct answer: C

Rationale: The correct action for the nurse to take first is to inform the anesthesia care provider. The patient's ingestion of coffee violates the NPO (nothing by mouth) guidelines before surgery, which increases the risk of aspiration during anesthesia. Informing the anesthesia care provider promptly allows for appropriate assessment and decision-making regarding the patient's anesthesia plan. Ensuring preoperative lab results, starting an IV, or contacting the obstetrician can be important steps but addressing the NPO violation and its implications on anesthesia safety take precedence.

3. A client with a history of myocardial infarction is experiencing chest pain. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Administer aspirin as prescribed.
• C. Administer nitroglycerin sublingually as prescribed.
• D. Obtain an electrocardiogram (ECG).

Correct answer: A

Rationale: Administering oxygen therapy is the initial priority in managing chest pain in a client with a history of myocardial infarction. Oxygen therapy helps improve oxygenation, which is crucial in reducing myocardial damage. While administering aspirin and nitroglycerin are essential interventions in the treatment of myocardial infarction, oxygen therapy takes precedence because it addresses the immediate need for oxygen supply to the heart muscle. Obtaining an ECG is important but can be done after ensuring adequate oxygenation.

4. A female client is admitted with end-stage pulmonary disease, is alert, oriented, and complaining of shortness of breath. The client tells the nurse that she wants 'no heroic measures' taken if she stops breathing, and she asks the nurse to document this in her medical record. What action should the nurse implement?

• A. Ask the client to discuss 'do not resuscitate' with her healthcare provider
• B. Document the client's wishes in her medical record
• C. Ask the client to sign an advance directive
• D. Place a 'Do Not Resuscitate' (DNR) order in the client's chart

Correct answer: A

Rationale: The correct action for the nurse to implement is to ask the client to discuss 'do not resuscitate' (DNR) wishes with her healthcare provider. This is important to ensure that the client makes informed decisions regarding her care. While documenting the client's wishes in her medical record is essential, it is crucial that the client discusses these wishes with the healthcare provider to understand the implications and have the DNR order legally documented. Asking the client to sign an advance directive is premature without a detailed discussion with the healthcare provider. Placing a 'Do Not Resuscitate' (DNR) order in the client's chart should only be done after the client has discussed and agreed upon this decision with the healthcare provider.

5. A newly graduated female staff nurse approaches the nurse manager and requests reassignment to another client because a male client is asking her for a date and making suggestive comments. Which response is best for the nurse manager to provide?

• A. I have to call the supervisor to get someone else to transfer to this unit to care for him.
• B. I know you are a good nurse and can handle this client in a professional manner.
• C. I'll talk to the client about his sexual harassment and insist that he stop immediately.
• D. I'll change your assignment, but let's talk about how a nurse should respond to this kind of client.

Correct answer: D

Rationale: The best response for the nurse manager is option D. Changing the assignment while providing guidance on professional boundaries and how to handle such situations is essential. Option A is not appropriate as it does not address the issue of the client's behavior. Option B, although supportive, does not offer a solution to the problem at hand. Option C is not the best approach as directly confronting the client about sexual harassment may escalate the situation further.

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