Nursing Elites

1. When assessing a client in crisis, what should the nurse prioritize?

• A. Allowing the client to work through independent problem-solving.
• B. Completing an in-depth evaluation of stressors and responses to the situation.
• C. Focusing on immediate stress reduction.
• D. Recommending ongoing therapy.

Correct answer: C

Rationale: When a client is in crisis, the nurse's priority is to focus on immediate stress reduction. Crisis intervention aims to stabilize the client in the present moment by addressing the most pressing issues. Allowing the client to work through independent problem-solving (Choice A) may not be appropriate during a crisis as they might need immediate support. Completing an in-depth evaluation of stressors (Choice B) is important but not the immediate priority during a crisis. Recommending ongoing therapy (Choice D) may be considered later, but the immediate focus should be on reducing the client's stress and stabilizing the situation.

2. A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?

• A. Hypernatremia
• B. Hypokalemia
• C. Myelosuppression
• D. Leukocytosis

Correct answer: B

Rationale: The correct answer is 'Hypokalemia.' The potassium level of 1.9 indicates low potassium levels, a condition known as hypokalemia. The other lab values are within normal ranges: Hgb 12.6, WBC 6500, uric acid 7.0, Na+ 136, and platelets 178,000. Hypernatremia (choice A) refers to high sodium levels, which are not present in this case. Myelosuppression (choice C) is a decrease in bone marrow activity, which is not indicated by the lab values provided. Leukocytosis (choice D) is an increase in white blood cells, which is also not present based on the given values.

3. While assessing a client who is dying for signs of impending death, what should the nurse observe for?

• A. Elevated blood pressure
• B. Cheyne-Stokes respiration
• C. Elevated pulse rate
• D. Decreased temperature

Correct answer: B

Rationale: When assessing a client for signs of impending death, the nurse should observe for Cheyne-Stokes respiration. This pattern involves rhythmic waxing and waning of respirations from very deep breathing to very shallow breathing with periods of temporary apnea. It is often associated with cardiac failure and can be a significant indicator of impending death. Elevated blood pressure and pulse rate are not typical signs of impending death; in fact, they may indicate other conditions. A decreased temperature is also not a common sign of impending death, as temperature changes can vary among individuals and may not always correlate with the dying process.

4. Hormonal agents are used to treat some cancers. An example is:

• A. thyroxine to treat thyroid cancer.
• B. ACTH to treat adrenal carcinoma.
• C. estrogen antagonists to treat breast cancer.
• D. glucagon to treat pancreatic carcinoma.

Correct answer: C

Rationale: Estrogen antagonists are commonly used to treat estrogen hormone-dependent cancers such as breast carcinoma. One well-known estrogen antagonist used in breast cancer therapy is Tamoxifen (Nolvadex). This drug, in combination with surgery and other chemotherapeutic drugs, reduces breast cancer recurrence by 30%. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history. Thyroxine is a thyroid hormone used to treat hypothyroidism, not thyroid cancer. ACTH is an anterior pituitary hormone that stimulates the adrenal glands to release glucocorticoids; it does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone that stimulates glycogenolysis and gluconeogenesis; it does not treat pancreatic cancer.

5. The nurse is caring for a client with cerebral palsy. The nurse should provide frequent rest periods because:

• A. Grimacing and writhing movements decrease with relaxation and rest.
• B. Hypoactive deep tendon reflexes become more active with rest.
• C. Stretch reflexes are increased with rest.
• D. Fine motor movements are improved.

Correct answer: A

Rationale: Frequent rest periods help to relax tense muscles and preserve energy in clients with cerebral palsy. This can lead to a decrease in grimacing and writhing movements, as relaxation and rest help to alleviate muscle tension. Choices B, C, and D are incorrect because they provide inaccurate information. Hypoactive deep tendon reflexes do not become more active with rest; stretch reflexes are not increased with rest in cerebral palsy patients, and fine motor movements are not necessarily improved solely by rest.

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