Nursing Elites

1. When a client with a history of atrial fibrillation is admitted with a new onset of confusion, which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: The correct answer is an Electrocardiogram (ECG). When a client with a history of atrial fibrillation presents with new-onset confusion, an ECG is crucial to assess for cardiac ischemia, which could be a potential cause of the confusion. A chest X-ray (Choice B) is not typically the first-line diagnostic test for evaluating confusion in a client with atrial fibrillation. Arterial blood gases (ABGs) (Choice C) are more useful in assessing oxygenation and acid-base balance rather than the cause of confusion in this scenario. While an echocardiogram (Choice D) provides valuable information about cardiac structure and function, it is usually not the initial diagnostic test needed in the evaluation of acute confusion in a client with atrial fibrillation.

2. The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value requires immediate intervention?

• A. Serum potassium of 5.5 mEq/L
• B. Serum creatinine of 2.5 mg/dL
• C. Hemoglobin of 10 g/dL
• D. White blood cell count of 10,000/mm³

Correct answer: A

Rationale: A serum potassium level of 5.5 mEq/L is most concerning in a client receiving erythropoietin therapy as it indicates hyperkalemia, requiring immediate intervention. High potassium levels can lead to severe cardiac arrhythmias and must be addressed promptly. The other laboratory values, though abnormal, do not present immediate life-threatening risks as hyperkalemia does.

3. An adult male with schizophrenia who has been noncompliant in taking oral antipsychotic medications refuses a prescribed IM medication. What action should the nurse take?

• A. Notify the healthcare provider of the client's refusal
• B. Attempt to convince the client to take the medication
• C. Administer the medication without the client's consent
• D. Document the refusal and take no further action

Correct answer: A

Rationale: The correct action is to notify the healthcare provider of the client's refusal. It is important for the healthcare provider to be informed so that they can decide on the next steps in the client's treatment, which may involve exploring alternative options or strategies. Attempting to convince the client to take the medication may not be effective, especially if the client is refusing. Administering the medication without the client's consent would violate the client's autonomy and rights. Simply documenting the refusal without further action may not address the client's treatment needs.

4. A male client with cancer, who is receiving antineoplastic drugs, is admitted to the hospital. What findings are most often manifested in this condition?

• A. Ecchymosis and hematemesis
• B. Weight loss and alopecia
• C. Weakness and activity intolerance
• D. Sore throat and fever

Correct answer: A

Rationale: The correct answer is A: Ecchymosis and hematemesis. These findings are often manifested in a client receiving antineoplastic drugs due to their potential side effects, including increased bleeding tendencies. Choice B, weight loss, and alopecia are more commonly associated with the side effects of cancer itself rather than antineoplastic drugs. Choice C, weakness, and activity intolerance can be seen in cancer patients but are not specific to antineoplastic drug therapy. Choice D, sore throat, and fever are less likely to be directly related to antineoplastic drugs and are more often linked to infections or other conditions.

5. In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen reservoir bag does not deflate completely during inspiration and the client's respiratory rate is 14 breaths/minute. What action should the nurse implement?

• A. Encourage the client to take deep breaths
• B. Remove the mask to deflate the bag
• C. Increase the liter flow of oxygen
• D. Document the assessment data

Correct answer: D

Rationale: The correct action for the nurse to implement is to document the assessment data. In this scenario, the findings indicate that the partial rebreather mask is functioning correctly as the reservoir bag should not deflate completely during inspiration. Additionally, the client's respiratory rate of 14 breaths/minute falls within the normal range. There is no need to encourage the client to take deep breaths, as the respiratory rate is normal, and doing so may disrupt the client's breathing pattern. Removing the mask to deflate the bag or increasing the liter flow of oxygen are unnecessary actions based on the assessment findings.

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