Nursing Elites

1. During the initial assessment of a client with a history of substance abuse admitted for detoxification, which intervention is most important?

• A. Obtain a detailed substance use history.
• B. Establish a trusting nurse-client relationship.
• C. Evaluate the client's physical health status.
• D. Determine the client's readiness for change.

Correct answer: C

Rationale: Assessing the client's physical health status is the most critical intervention during the initial assessment of a client with a history of substance abuse admitted for detoxification. This evaluation helps identify and address any immediate health risks, such as withdrawal symptoms or medical complications, to ensure the client's safety and well-being during the detoxification process. Option A, obtaining a detailed substance use history, is important but not the most critical initially. Option B, establishing a trusting nurse-client relationship, is important but assessing physical health takes precedence. Option D, determining the client's readiness for change, is valuable but assessing physical health for immediate risks is the priority.

2. A patient with coronary artery disease (CAD) is prescribed a statin medication. What should the nurse include in the patient education?

• A. Take the medication with food.
• B. Report any muscle pain or weakness.
• C. Increase intake of grapefruit juice.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: Patients prescribed statin medications should be educated to report any muscle pain or weakness to their healthcare provider promptly. Muscle pain or weakness could be a sign of rhabdomyolysis, a serious side effect associated with statin use that requires medical attention. Choices A, C, and D are incorrect. Taking statins with food or increasing grapefruit juice intake are not necessary recommendations. Avoiding foods high in potassium is also not directly related to statin use.

3. A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?

• A. Inflammatory bowel disease
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Lactose intolerance

Correct answer: B

Rationale: The patient's symptoms of chronic constipation, bloating, abdominal pain relieved with defecation, absence of weight loss, blood in stools, or nocturnal symptoms, along with normal physical examination and routine blood tests, are indicative of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of any organic cause. It is a diagnosis of exclusion made based on symptom criteria, and the provided clinical scenario aligns with the typical presentation of IBS.

4. What instruction should a patient with a history of hypertension be provided when being discharged with a prescription for a thiazide diuretic?

• A. Avoid foods high in potassium.
• B. Take the medication at bedtime.
• C. Monitor weight daily.
• D. Limit fluid intake to 1 liter per day.

Correct answer: C

Rationale: The correct instruction for a patient with a history of hypertension being discharged with a prescription for a thiazide diuretic is to monitor weight daily. This is important because thiazide diuretics can cause fluid imbalances, and monitoring weight daily can help detect significant changes early. Choice A, avoiding foods high in potassium, is not directly related to thiazide diuretics. Choice B, taking the medication at bedtime, may vary depending on the specific medication but is not a universal instruction. Choice D, limiting fluid intake to 1 liter per day, is not appropriate as adequate hydration is important to prevent complications like hypokalemia.

5. When teaching a client postoperative breathing techniques with an incentive spirometer (IS), what should the nurse encourage the client to do to maintain sustained maximal inspiration?

• A. Exhale forcefully into the tubing for 3 to 5 seconds.
• B. Inspire deeply and slowly over 3 to 5 seconds.
• C. Breathe into the spirometer using normal breath volumes.
• D. Perform IS breathing exercises every 6 hours.

Correct answer: B

Rationale: To maintain sustained maximal inspiration when using an incentive spirometer, the client should be encouraged to inspire deeply and slowly over 3 to 5 seconds. This technique aids in achieving the goal of sustained maximal inspiration, which is essential for postoperative respiratory recovery.

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