Nursing Elites

1. A 26-year-old female client is admitted to the hospital for treatment of a simple goiter, and levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the nurse that the prescribed dosage is too high for this client?

• A. Palpitations and shortness of breath
• B. Bradycardia and constipation
• C. Lethargy and lack of appetite
• D. Muscle cramping and dry, flushed skin

Correct answer: A

Rationale: The correct answer is A. An overdose of thyroid preparation generally manifests symptoms of an agitated state such as tremors, palpitations, shortness of breath, tachycardia, increased appetite, agitation, sweating, and diarrhea. Palpitations and shortness of breath are signs of excessive thyroid medication. Choices B, C, and D are incorrect symptoms for a dosage that is too high. Bradycardia and constipation, lethargy and lack of appetite, muscle cramping and dry, flushed skin are more indicative of hypothyroidism or an insufficient dosage of levothyroxine.

2. A client with hyperthyroidism who has not been responsive to medications is admitted for evaluation. What action should the nurse implement?

• A. Notify the healthcare provider.
• B. Review the client's medication history.
• C. Prepare the client for thyroid function tests.
• D. Initiate seizure precautions.

Correct answer: A

Rationale: In a scenario where a client with hyperthyroidism is not responding to medications, the nurse's priority action should be to notify the healthcare provider. This is important because the client may require immediate intervention, such as adjusting the treatment plan or exploring alternative therapies. Reviewing the client's medication history (choice B) may be relevant but not as urgent as involving the healthcare provider. While preparing the client for thyroid function tests (choice C) may be necessary as part of the evaluation process, it is not the most immediate action to take. Initiating seizure precautions (choice D) is not directly related to the non-responsiveness of medications in hyperthyroidism and is not a priority in this situation.

3. A male client with hypertension, who received new antihypertensive prescriptions at his last visit, returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106, and he admits that he has not been taking the prescribed medication because the drugs make him 'feel bad'. In explaining the need for hypertension control, the nurse should stress that an elevated BP places the client at risk for which pathophysiological condition?

• A. Blindness due to cataracts
• B. Acute kidney injury due to glomerular damage
• C. Stroke secondary to hemorrhage
• D. Heart block due to myocardial damage

Correct answer: C

Rationale: The correct answer is C, 'Stroke secondary to hemorrhage.' Uncontrolled hypertension can lead to the weakening of blood vessels in the brain, increasing the risk of a stroke due to hemorrhage. This can result in serious neurological deficits or even death. Choices A, B, and D are incorrect because while hypertension can have various complications including vision changes, kidney damage, and heart problems, the most immediate and severe risk associated with uncontrolled hypertension is a stroke from cerebral hemorrhage.

4. In a client with liver cirrhosis admitted with ascites and jaundice, which laboratory value is most concerning to the nurse?

• A. Serum albumin of 3.0 g/dl
• B. Bilirubin of 3.0 mg/dl
• C. Ammonia level of 80 mcg/dl
• D. Prothrombin time of 18 seconds

Correct answer: C

Rationale: An elevated ammonia level of 80 mcg/dl is most concerning in a client with liver cirrhosis because it may indicate hepatic encephalopathy, a serious complication. Serum albumin, though low, is expected in cirrhosis and contributes to ascites. Bilirubin elevation is common in liver disease but may not be the most concerning in this case. Prothrombin time is typically prolonged in liver disease but may not be as acute as an elevated ammonia level suggesting hepatic encephalopathy.

5. An older male client with a history of diabetes mellitus, chronic gout, and osteoarthritis comes to the clinic with a bag of medication bottles. Which intervention should the nurse implement first?

• A. Identify pills in the bag
• B. Review the client's medication schedule
• C. Assess the client's symptoms
• D. Educate the client about proper medication usage

Correct answer: A

Rationale: The correct answer is to identify pills in the bag first. This is essential to ensure the client is taking the correct medications and to prevent any potential medication errors. Reviewing the client's medication schedule (choice B) can come after identifying the pills to cross-reference the medications. Assessing the client's symptoms (choice C) is important but should follow identifying the medications. Educating the client about proper medication usage (choice D) is crucial but should be done after confirming the medications in the bag.

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