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. A client with lupus erythematosus is prescribed prednisone. What teaching should the nurse include?

• A. Take the medication with food to prevent stomach upset.
• B. Avoid crowded places to reduce the risk of infection.
• C. Take the medication in the morning to prevent insomnia.
• D. Take extra calcium supplements to prevent osteoporosis.

Correct answer: B

Rationale: The correct teaching for a client with lupus erythematosus prescribed prednisone is to avoid crowded places to reduce the risk of infection. Prednisone suppresses the immune system, making individuals more susceptible to infections. Taking the medication with food may help reduce stomach upset but is not the priority teaching. Taking prednisone in the morning may help reduce insomnia, but infection prevention is more critical. While prednisone can lead to osteoporosis, advising extra calcium supplements is not the most immediate concern when starting the medication.

3. A client with Cushing's syndrome presents with excessive bruising and elevated blood glucose. What action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer insulin per sliding scale protocol.
• C. Administer intravenous fluids.
• D. Check the client's skin for signs of bruising.

Correct answer: A

Rationale: Excessive bruising and elevated blood glucose are common symptoms of Cushing's syndrome. The nurse should first check the client's blood glucose level to assess and address the hyperglycemia promptly. Administering insulin or IV fluids would be premature without knowing the current blood glucose level. Checking the skin for bruising, although important for overall assessment, does not address the immediate concern of elevated blood glucose.

4. A client with type 1 diabetes is found unconscious with a blood glucose of 40 mg/dL. What is the nurse's priority intervention?

• A. Administer a 50% dextrose bolus intravenously.
• B. Administer glucagon intramuscularly.
• C. Provide oral glucose gel.
• D. Recheck the blood glucose level in 15 minutes.

Correct answer: A

Rationale: The correct answer is to administer a 50% dextrose bolus intravenously. In unconscious clients with hypoglycemia, IV dextrose rapidly raises the blood glucose level. Glucagon would be a slower option and is typically used if IV access is unavailable. Oral glucose gel is not appropriate for an unconscious client as it requires swallowing and may cause aspiration. Rechecking the blood glucose level in 15 minutes delays immediate treatment and could lead to further deterioration.

5. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who has been experiencing increasing shortness of breath. Which finding requires immediate intervention?

• A. A respiratory rate of 26 breaths per minute
• B. Use of accessory muscles for breathing
• C. Barrel chest appearance
• D. A pulse oximetry reading of 88%

Correct answer: D

Rationale: A pulse oximetry reading of 88% indicates hypoxemia, which requires immediate intervention to improve oxygenation. Hypoxemia can lead to serious complications if not addressed promptly. While a respiratory rate of 26 breaths per minute and the use of accessory muscles for breathing are concerning in COPD, they do not indicate an immediate life-threatening situation. Similarly, a barrel chest appearance is a common finding in COPD and does not require urgent intervention compared to the critical need to address hypoxemia.

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