Nursing Elites

1. A nurse is reviewing the laboratory results for a client who has end-stage liver disease. Which of the following findings should the nurse expect?

• A. Elevated albumin
• B. Elevated ammonia
• C. Decreased total bilirubin
• D. Decreased prothrombin time

Correct answer: B

Rationale: In end-stage liver disease, the liver's inability to convert ammonia into urea leads to elevated ammonia levels. Elevated ammonia levels can result in hepatic encephalopathy, a serious complication. Therefore, the correct answer is B. Elevated albumin (Choice A) is not typically seen in end-stage liver disease as liver dysfunction often leads to decreased albumin levels. Decreased total bilirubin (Choice C) is unlikely in end-stage liver disease, as bilirubin levels tend to be elevated due to impaired liver function. Decreased prothrombin time (Choice D) is also not expected in end-stage liver disease, as impaired liver function results in prolonged prothrombin time.

2. A nurse working in a mental health facility observes a client who has bipolar disorder walk over to a table occupied by other clients and knock their game off the table. Which of the following is an appropriate response by the nurse?

• A. Apologize to the others for your behavior.
• B. I am disappointed that you continue to act out when you are angry.
• C. Come outside with me for a walk.
• D. If you don't calm down, you will have to go into seclusion.

Correct answer: C

Rationale: Offering to go for a walk with the client helps redirect their energy in a non-confrontational way, avoiding escalation of aggressive behavior while promoting de-escalation.

3. A nurse is preparing to administer 2.5 mL of medication intramuscularly to an adult client. Which site is safest for the nurse to use?

• A. Ventrogluteal
• B. Dorsogluteal
• C. Vastus lateralis
• D. Rectus femoris

Correct answer: A

Rationale: The correct answer is 'Ventrogluteal.' The ventrogluteal site is recommended for intramuscular injections in adults because it is free of major blood vessels and nerves, reducing the risk of injury or complications. Choice B, 'Dorsogluteal,' is not recommended due to the proximity of the sciatic nerve and major blood vessels. Choices C and D, 'Vastus lateralis' and 'Rectus femoris,' are sites commonly used for intramuscular injections but are more suitable for pediatric or specific population groups, not typically for adults.

4. A client is being taught how to use a diaphragm for contraception. Which of the following client statements indicate an understanding of the teaching?

• A. I will leave the diaphragm in place for at least 6 hours after intercourse.
• B. I will remove the diaphragm by catching the rim below the dome with my finger.
• C. I will not apply mineral oil on the diaphragm.
• D. I will place 2 teaspoons of spermicide on the inside of the diaphragm before inserting it.

Correct answer: D

Rationale: The correct answer is D. The client should place spermicide inside the diaphragm before insertion to enhance contraceptive effectiveness. It is recommended to leave the diaphragm in place for at least 6 hours after intercourse, but not more than 24 hours. Choice A is incorrect because the diaphragm should be left in place for at least 6 hours, not 4 hours. Choice B is incorrect as the diaphragm should be removed by hooking the rim below the dome, not above. Choice C is incorrect because mineral oil should not be used with the diaphragm as it can weaken the latex.

5. A menopausal client is having difficulty getting to sleep and asks what actions she should incorporate into her daily routine to promote sleep. The nurse would encourage which of the following measures to promote sleep?

• A. Consume a warm drink at bedtime
• B. Take an evening walk before bedtime
• C. Take an afternoon nap
• D. Limit alcohol and nicotine prior to bedtime

Correct answer: D

Rationale: The correct answer is D: Limit alcohol and nicotine prior to bedtime. Alcohol and nicotine are stimulants that can disrupt sleep patterns, so avoiding them before bedtime can promote better sleep. Choices A, B, and C are incorrect. Consuming a warm drink at bedtime may lead to frequent urination, disrupting sleep; taking an evening walk before bedtime may increase alertness rather than inducing sleep; and taking an afternoon nap can make it harder to fall asleep at night.

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