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. The healthcare provider is caring for a client with Guillain-Barré syndrome. Which assessment finding requires the healthcare provider's immediate action?

• A. Loss of deep tendon reflexes.
• B. Ascending weakness.
• C. New onset of confusion.
• D. Decreased vital capacity.

Correct answer: D

Rationale: Decreased vital capacity is the most critical assessment finding in a client with Guillain-Barré syndrome as it indicates respiratory compromise. This requires immediate intervention to ensure adequate ventilation and prevent respiratory failure, a common complication of this syndrome. Monitoring and maintaining respiratory function are vital in these clients to prevent complications such as respiratory distress, hypoxia, and respiratory failure. Loss of deep tendon reflexes and ascending weakness are typical manifestations of Guillain-Barré syndrome but do not require immediate action compared to compromised respiratory function. New onset of confusion may be a concern but is not as immediately life-threatening as decreased vital capacity.

3. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

4. A patient with gout is prescribed allopurinol. What should the nurse include in the patient teaching?

• A. Take the medication with food.
• B. Increase intake of high-purine foods.
• C. Limit fluid intake to 1 liter per day.
• D. Expect immediate pain relief.

Correct answer: A

Rationale: When educating a patient prescribed allopurinol for gout, the nurse should emphasize taking the medication with food to reduce the risk of gastrointestinal upset. It is important to instruct the patient to maintain adequate hydration by consuming plenty of fluids, preferably water, to help prevent kidney stone formation and facilitate the drug's effectiveness. Allopurinol does not provide immediate pain relief but rather works to lower uric acid levels over time, reducing the frequency of gout attacks. Choices B and C are incorrect as increasing high-purine foods can exacerbate gout symptoms, and limiting fluid intake to 1 liter per day is not recommended for gout patients who should maintain good hydration. Choice D is incorrect because allopurinol does not offer immediate pain relief.

5. A client with chronic kidney disease (CKD) has an arteriovenous (AV) fistula for hemodialysis. Which finding should the nurse report to the healthcare provider immediately?

• A. No bruit or thrill over the AV fistula.
• B. Redness at the site of the AV fistula.
• C. Client's complaint of pain at the AV fistula site.
• D. Swelling of the hand on the side of the AV fistula.

Correct answer: A

Rationale: In a client with a chronic kidney disease who has an arteriovenous (AV) fistula for hemodialysis, the absence of a bruit (a humming sound) or thrill (vibratory sensation) over the AV fistula indicates a potential occlusion. This finding suggests inadequate blood flow through the AV fistula, which is a critical issue requiring immediate intervention to prevent complications such as thrombosis or clot formation. Reporting this absence of bruit or thrill promptly to the healthcare provider is essential to ensure timely assessment and management to maintain vascular access for hemodialysis.

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