Nursing Elites

1. A client with hypothyroidism is prescribed levothyroxine. What assessment finding suggests the medication dosage is too high?

• A. Increased sensitivity to cold.
• B. Increased heart rate and palpitations.
• C. Improved energy levels.
• D. Improved tolerance to heat.

Correct answer: B

Rationale: The correct answer is B: Increased heart rate and palpitations. When a client with hypothyroidism is prescribed levothyroxine, these symptoms may indicate that the dosage is too high, causing the client to develop hyperthyroidism. Choices A, C, and D are incorrect. Increased sensitivity to cold is a symptom of hypothyroidism, improved energy levels are an expected outcome of levothyroxine therapy for hypothyroidism, and improved tolerance to heat is not a common sign of levothyroxine overdose.

2. When assessing a client, why is it important for the nurse to be informed about cultural issues related to the client's background?

• A. Normal patterns of behavior may be labeled as deviant, immoral, or insane
• B. The meaning of the client's behavior can be derived from conventional wisdom
• C. Personal values will guide the interaction between individuals from different cultures
• D. The nurse should rely on her knowledge of different developmental mental stages

Correct answer: A

Rationale: Being aware of cultural differences is crucial because normal behaviors in one culture may be perceived as deviant, immoral, or insane in another. This awareness helps the nurse avoid misunderstandings or misinterpretations of behaviors that are considered acceptable in the client's cultural context but may be viewed differently in another. Choices B, C, and D are incorrect because understanding cultural issues goes beyond deriving meanings from conventional wisdom, personal values guiding interactions, or relying solely on knowledge of developmental mental stages.

3. A client with hyperkalemia is receiving insulin and glucose. Which laboratory value should the nurse monitor closely?

• A. Monitor the client's blood glucose level.
• B. Monitor the client's sodium level.
• C. Monitor the client's calcium level.
• D. Monitor the client's potassium level.

Correct answer: D

Rationale: The correct answer is to monitor the client's potassium level. When administering insulin and glucose in hyperkalemia, the aim is to shift potassium from the bloodstream into the cells, lowering elevated levels. Therefore, monitoring potassium levels closely is essential to prevent hypokalemia or further complications. Monitoring blood glucose levels (Choice A) is important but not the priority in this scenario. Monitoring sodium (Choice B) and calcium levels (Choice C) is not directly related to the treatment of hyperkalemia with insulin and glucose.

4. An older client with SIRS has a temperature of 101.8°F, a heart rate of 110 beats per minute, and a respiratory rate of 24 breaths per minute. Which additional finding is most important to report to the healthcare provider?

• A. Serum creatinine of 2.0 mg/dL
• B. Elevated WBC count
• C. Blood pressure of 100/60 mmHg
• D. Oxygen saturation of 95%

Correct answer: A

Rationale: A serum creatinine level of 2.0 mg/dL indicates possible acute kidney injury, which can occur during severe systemic inflammatory response syndrome (SIRS). Reporting this value promptly allows for interventions to prevent further renal damage. Elevated WBC count (choice B) is a common feature of SIRS and may not be as urgently indicative of immediate organ damage as high creatinine levels. A blood pressure of 100/60 mmHg (choice C) is relatively low but may be a typical finding in SIRS; however, renal function is critical in this context. Oxygen saturation of 95% (choice D) is within normal limits and is not as concerning as a high creatinine level in this scenario.

5. A client with hypothyroidism is prescribed levothyroxine. What instruction should the nurse provide?

• A. Take the medication in the morning before eating.
• B. Take the medication with a full glass of water.
• C. Take the medication with food to avoid nausea.
• D. Take the medication only when symptoms worsen.

Correct answer: A

Rationale: The correct answer is A: 'Take the medication in the morning before eating.' Levothyroxine should be taken on an empty stomach in the morning for optimal absorption. Choice B is incorrect because while taking medication with water is generally recommended, levothyroxine specifically needs to be taken on an empty stomach. Choice C is incorrect as taking levothyroxine with food can interfere with its absorption. Choice D is incorrect as levothyroxine should be taken regularly as prescribed, not only when symptoms worsen.

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