Nursing Elites

1. A client who had a subtotal parathyroidectomy two days ago is now preparing for discharge. Which assessment finding requires immediate provider notification?

• A. Afebrile with a normal pulse.
• B. No bowel movement since surgery.
• C. No appetite for breakfast.
• D. A positive Chvostek's sign.

Correct answer: D

Rationale: A positive Chvostek's sign suggests hypocalcemia, which is a post-parathyroidectomy complication and requires prompt treatment. The other options are less urgent: being afebrile with a normal pulse is expected, no bowel movement since surgery can be managed with interventions like early ambulation and stool softeners, and no appetite for breakfast is common postoperatively and can be addressed without immediate provider notification.

2. During an excretory urogram, which observation made by the nurse indicates a complication?

• A. The client complains of a salty taste in the mouth when the dye is injected
• B. The client's entire body turns a bright red color
• C. The client states 'I have a feeling of getting warm.'
• D. The client gags and complains 'I am getting sick.'

Correct answer: B

Rationale: The correct answer is B because a whole-body bright red color indicates a severe reaction to the contrast dye and must be addressed immediately. Choices A, C, and D do not indicate a severe complication during an excretory urogram. Choice A is a common side effect of the dye, choice C could be a normal sensation due to the injection, and choice D may indicate nausea which is less severe compared to a whole-body red color reaction.

3. A client with deep vein thrombosis (DVT) is prescribed warfarin. What lab value should the nurse review before administering the medication?

• A. Prothrombin time (PT)
• B. Hemoglobin and hematocrit (H&H)
• C. International Normalized Ratio (INR)
• D. Partial thromboplastin time (PTT)

Correct answer: C

Rationale: The correct answer is C: International Normalized Ratio (INR). Before administering warfarin to a client with deep vein thrombosis, the nurse should review the INR to ensure the client is within the therapeutic range. INR is specifically monitored for patients on warfarin therapy to assess the clotting ability of the blood. Choices A, B, and D are incorrect as they are not the primary lab value used to monitor warfarin therapy. Prothrombin time (PT) is used to measure how long blood takes to clot. Hemoglobin and hematocrit (H&H) assess for anemia and the blood's oxygen-carrying capacity. Partial thromboplastin time (PTT) is used to monitor heparin therapy, not warfarin.

4. A client is admitted with a diagnosis of schizophrenia. The client refuses to take medication and states 'I don't think I need those medications. They make me too sleepy and drowsy. I insist that you explain their use and side effects.' The nurse should understand that

• A. A referral is needed to the psychiatrist who is to provide the client with answers
• B. The client has a right to know about the prescribed medications
• C. Such education is an independent decision of the individual nurse whether or not to teach clients about their medications
• D. Clients with schizophrenia are at a higher risk of psychosocial complications when they know about their medication side effects

Correct answer: B

Rationale: The correct answer is B. The client has a legal right to be informed about their treatment, including medication uses and side effects, as part of informed consent. This helps ensure that the client can make an informed decision about their care. Choice A is incorrect because the nurse can provide the client with information about their medications. Choice C is incorrect as it is not an independent decision of the nurse but a professional responsibility to educate clients. Choice D is incorrect as knowledge about medication side effects can actually empower clients to manage their condition effectively.

5. A client with Alzheimer's disease is prescribed donepezil. What is the most important teaching point?

• A. Take the medication as directed for best results.
• B. Report any unusual changes in behavior.
• C. This medication helps improve cognitive function.
• D. This medication is not a cure for Alzheimer's disease.

Correct answer: C

Rationale: The most important teaching point for a client prescribed donepezil is that it helps improve cognitive function. While it is important to take the medication as directed for best results (choice A) and report any unusual changes in behavior (choice B), the key point is that donepezil is not a cure for Alzheimer's disease (choice D). Therefore, the correct answer is C.

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