Nursing Elites

1. A client with hypothyroidism is prescribed levothyroxine. What symptom indicates that the dosage may need adjustment?

• A. Increased appetite and weight gain.
• B. Increased sensitivity to cold and dry skin.
• C. Increased heart palpitations and sweating.
• D. Increased shortness of breath and rapid heart rate.

Correct answer: B

Rationale: Increased sensitivity to cold and dry skin may indicate that the dosage of levothyroxine is too low, requiring adjustment. This symptom is typical of hypothyroidism when the body's metabolism slows down, leading to feeling cold and having dry skin. Choices A, C, and D present symptoms more commonly associated with hyperthyroidism, where the body is in a state of overactivity, leading to weight loss, increased heart rate, and sweating. Therefore, these symptoms would not indicate the need for dosage adjustment in a client with hypothyroidism.

2. A client with chronic kidney disease is prescribed erythropoietin. What lab value should the nurse monitor to evaluate the effectiveness of the therapy?

• A. White blood cell count.
• B. Hemoglobin level.
• C. Serum creatinine level.
• D. Platelet count.

Correct answer: B

Rationale: Erythropoietin therapy stimulates red blood cell production in clients with chronic kidney disease. Hemoglobin levels should be monitored to assess the effectiveness of the therapy and ensure the client is not developing anemia. Increased hemoglobin levels indicate successful treatment, whereas very high levels may suggest erythropoietin is overcorrecting the anemia. Monitoring the white blood cell count is not directly related to erythropoietin therapy for anemia. Serum creatinine level is used to assess kidney function rather than the effectiveness of erythropoietin therapy. Platelet count is not typically affected by erythropoietin therapy and is not a key indicator of its effectiveness.

3. Which client is at greatest risk for developing delirium?

• A. An adult client who cannot sleep due to pain.
• B. An older client who attempted suicide 1 month ago.
• C. A young adult taking antipsychotic medications twice daily.
• D. A middle-aged woman using supplemental oxygen.

Correct answer: B

Rationale: The correct answer is B. Older adults who have attempted suicide are at higher risk for developing delirium, especially in the context of underlying mental health conditions. Choice A is incorrect as sleep disturbances due to pain may lead to discomfort but not necessarily delirium. Choice C is incorrect as taking antipsychotic medications, if managed well, does not inherently increase the risk of delirium. Choice D is incorrect as using supplemental oxygen alone does not significantly increase the risk of developing delirium.

4. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy. Which assessment finding indicates that the client's oxygenation is improving?

• A. Pulse oximetry reading of 94%
• B. Heart rate increases from 80 to 90 beats per minute
• C. Respiratory rate increases from 16 to 20 breaths per minute
• D. Client reports increased energy levels

Correct answer: A

Rationale: A pulse oximetry reading of 94% indicates adequate oxygenation. Monitoring oxygen saturation is the most objective way to assess the effectiveness of oxygen therapy. Choices B, C, and D do not directly reflect the client's oxygenation status. An increase in heart rate or respiratory rate may indicate increased work of breathing or stress on the body. The client reporting increased energy levels is subjective and may not directly correlate with improved oxygenation.

5. A client is scheduled for surgery in the morning and is NPO. Which statement indicates that the client understands the reason for being NPO?

• A. Being NPO helps reduce the risk of nausea.
• B. I should not eat or drink anything to prevent complications during surgery.
• C. NPO reduces the risk of aspiration during surgery.
• D. NPO helps ensure the stomach is empty during surgery.

Correct answer: C

Rationale: The correct answer is C: 'NPO reduces the risk of aspiration during surgery.' When a client is NPO (nothing by mouth) before surgery, it is to prevent aspiration, which can lead to serious complications such as pneumonia. Choice A is incorrect because being NPO is more about preventing aspiration than nausea. Choice B is a general statement without specifying the reason for being NPO. Choice D is partially correct but does not emphasize the crucial aspect of preventing aspiration, which is the primary reason for fasting before surgery.

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