Nursing Elites

1. A client with a history of chronic alcoholism is admitted with confusion, ataxia, and diplopia. Which nursing intervention is a priority for this client?

• A. Monitor for signs of alcohol withdrawal.
• B. Administer thiamine as prescribed.
• C. Provide a quiet environment to reduce confusion.
• D. Initiate fall precautions.

Correct answer: B

Rationale: The correct answer is to administer thiamine as prescribed. This intervention is a priority for clients with chronic alcoholism to prevent Wernicke's encephalopathy, a serious complication of thiamine deficiency. Monitoring for signs of alcohol withdrawal (choice A) is important but not the priority in this scenario. Providing a quiet environment (choice C) may be beneficial but does not address the immediate need to prevent Wernicke's encephalopathy. Initiating fall precautions (choice D) is also important but not the priority compared to administering thiamine to prevent a life-threatening condition.

2. The nurse is assessing a client with left-sided heart failure. Which laboratory value is most concerning?

• A. Serum creatinine of 1.5 mg/dL
• B. Serum sodium of 136 mEq/L
• C. Serum potassium of 5.5 mEq/L
• D. Hemoglobin of 12 g/dL

Correct answer: C

Rationale: A serum potassium level of 5.5 mEq/L is most concerning in a client with left-sided heart failure as it indicates hyperkalemia, requiring immediate intervention. Hyperkalemia can lead to life-threatening cardiac arrhythmias, which can exacerbate heart failure. Serum creatinine of 1.5 mg/dL is slightly elevated but not as immediately concerning as hyperkalemia. Serum sodium of 136 mEq/L is within the normal range. Hemoglobin of 12 g/dL is also within the normal range and not directly related to the client's left-sided heart failure.

3. A client with newly diagnosed peptic ulcer disease is being taught about lifestyle modifications. Which client statement indicates that further teaching is needed?

• A. ‘I should avoid eating spicy foods to prevent irritation of my ulcer.’
• B. ‘I should take my antacids regularly, even if I don’t have symptoms.’
• C. ‘I should avoid smoking to prevent exacerbation of my symptoms.’
• D. ‘I should avoid drinking alcohol to prevent irritation of my ulcer.’

Correct answer: D

Rationale: The corrected question assesses the client's understanding of lifestyle modifications for peptic ulcer disease. Choice D, 'I should avoid drinking alcohol to prevent irritation of my ulcer,' is the correct answer. This statement demonstrates that the client has a good grasp of the teaching provided, as alcohol can indeed irritate peptic ulcers. Choices A, B, and C are all accurate statements that reflect appropriate understanding of managing peptic ulcer disease and do not indicate a need for further teaching.

4. After a sudden loss of consciousness, a female client is taken to the ED, and the initial assessment indicates that her blood glucose level is critically low. Once her glucose level is stabilized, the client reports that she was recently diagnosed with anorexia nervosa and is being treated at an outpatient clinic. Which intervention is most important to include in this client's discharge plan?

• A. Describe the signs and symptoms of hypoglycemia.
• B. Encourage a low-carbohydrate and high-protein diet.
• C. Reinforce the need to continue outpatient treatment.
• D. Suggest wearing a medical alert bracelet at all times.

Correct answer: B

Rationale: Encouraging a low-carbohydrate and high-protein diet is crucial for a client recovering from anorexia nervosa to prevent hypoglycemic episodes. Choice A is not the most important intervention at this point since the client is already aware of hypoglycemia based on the recent event. Choice C is important but not the priority in this situation where dietary intervention is crucial. Choice D, suggesting a medical alert bracelet, is not as essential as ensuring proper nutrition to prevent further hypoglycemic episodes.

5. The nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for hemodialysis. Which clinical finding is most concerning?

• A. Blood pressure of 110/70 mmHg
• B. Heart rate of 110 beats per minute
• C. Fever of 100.4°F
• D. Respiratory rate of 24 breaths per minute

Correct answer: C

Rationale: The correct answer is C. A fever of 100.4°F is most concerning in a client with ESRD scheduled for hemodialysis because it may indicate an underlying infection that requires immediate attention. Elevated body temperature can be a sign of systemic infection, which can quickly worsen in individuals with compromised renal function. Monitoring for infection is crucial in ESRD patients to prevent complications. Choices A, B, and D are not as immediately concerning in this context. While variations in blood pressure, heart rate, and respiratory rate should be monitored, they are not as indicative of a potentially severe issue as an unexplained fever in this scenario.

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