Nursing Elites

1. A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?

• A. I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.
• B. It's hard to believe that there are actually medications that can treat obesity.
• C. I'm a bit nervous to start this medication because I know I'll need blood tests sometimes.
• D. I'm going to have to do some rearranging of my finances to make sure I can afford this medication.

Correct answer: A

Rationale: Choice A suggests the need for further health education as the client expresses a reluctance to exercise or change dietary habits, indicating a lack of understanding about the importance of lifestyle modifications in conjunction with medication for effective weight management. It is important for the client to comprehend that a holistic approach, including lifestyle changes, is crucial for successful obesity treatment and long-term health benefits.

2. A 45-year-old woman presents with fatigue, weight gain, and constipation. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The combination of high TSH and low free T4 levels is consistent with hypothyroidism, which matches the patient's symptoms of fatigue, weight gain, and constipation. In hypothyroidism, the thyroid gland does not produce enough thyroid hormones, leading to a decrease in metabolic rate and resulting in these clinical findings.

3. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which laboratory value indicates a therapeutic effect of the medication?

• A. INR of 2.5.
• B. PTT of 45 seconds.
• C. Hemoglobin of 12 g/dL.
• D. Platelet count of 150,000/mm³.

Correct answer: A

Rationale: An INR (International Normalized Ratio) of 2.5 indicates a therapeutic level for clients receiving warfarin (Coumadin) to prevent thromboembolism. It is essential to monitor INR levels regularly when on warfarin therapy to ensure that the blood's ability to clot is within the desired range to prevent both clotting and excessive bleeding.

4. What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?

• A. Soft, spongy fundus.
• B. Saturating two perineal pads per hour.
• C. Pulse rate of 56 BPM.
• D. Unilateral lower leg pain.

Correct answer: C

Rationale: The correct answer is C. A pulse rate of 56 BPM can be considered a normal finding for a primigravida client who is 12 hours postpartum. Postpartum bradycardia can occur due to increased stroke volume and decreased vascular resistance after delivery. It is important for the nurse to monitor the client's vital signs and recognize that a lower pulse rate can be expected in the immediate postpartum period. Choices A, B, and D are incorrect because a soft, spongy fundus may indicate uterine atony, saturating two perineal pads per hour is excessive bleeding, and unilateral lower leg pain could suggest deep vein thrombosis, all of which would require further assessment and intervention.

5. A patient with chronic kidney disease (CKD) is prescribed calcium acetate. What is the primary purpose of this medication?

• A. Treat hyperkalemia
• B. Reduce phosphate levels
• C. Lower blood pressure
• D. Increase hemoglobin levels

Correct answer: B

Rationale: The primary purpose of prescribing calcium acetate to a patient with chronic kidney disease (CKD) is to reduce phosphate levels. Calcium acetate binds to dietary phosphate, preventing its absorption and helping to manage hyperphosphatemia commonly seen in CKD patients.

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