Nursing Elites

1. A nurse receives a change-of-shift report. Which of the following clients should the nurse attend to first?

• A. A client who reports tingling in the fingers following a thyroidectomy
• B. A client who has dark, foul-smelling urine with a urine output of 320 mL in the last 8 hr
• C. A client who is in a long leg cast and reports cool feet bilaterally
• D. A client who has a productive cough and an oral temperature of 36°C (96.8°F)

Correct answer: C

Rationale: The correct answer is C. Cool feet bilaterally in a client with a long leg cast may indicate compromised circulation, which is a medical emergency that requires immediate intervention. Choices A, B, and D do not present immediate life-threatening conditions. Tingling in the fingers following a thyroidectomy may indicate hypocalcemia but does not require immediate attention. Dark, foul-smelling urine with decreased urine output indicates a possible urinary tract infection or dehydration but can be addressed after attending to the client with compromised circulation. A productive cough and a normal oral temperature do not suggest an urgent condition compared to compromised circulation in a client with a long leg cast.

2. A nurse is caring for a client who is in labor and has a diagnosis of group B streptococcus ß-hemolytic infection. Which of the following medications should the nurse plan to administer?

• A. Ampicillin
• B. Azithromycin
• C. Ceftriaxone
• D. Acyclovir

Correct answer: A

Rationale: Ampicillin is the correct choice for treating group B streptococcus infections in pregnant women during labor to prevent neonatal infection. Group B streptococcus is commonly treated with penicillin or ampicillin; therefore, choices B, C, and D are incorrect. Azithromycin is not the first-line treatment for group B streptococcus. Ceftriaxone is not the preferred antibiotic for this infection during labor. Acyclovir is an antiviral medication used for herpes simplex virus infections, not bacterial infections like group B streptococcus.

3. A nurse is caring for a client with a history of substance abuse. Which of the following interventions should the nurse prioritize?

• A. Monitor for withdrawal symptoms
• B. Encourage social activities
• C. Schedule regular follow-ups
• D. Provide educational materials

Correct answer: A

Rationale: The correct answer is to monitor for withdrawal symptoms. This is a priority because individuals with a history of substance abuse are at risk of experiencing withdrawal symptoms when the substance is no longer used. Monitoring for withdrawal symptoms is crucial to ensure the client's safety and to manage any potential complications related to substance withdrawal. Encouraging social activities, scheduling regular follow-ups, and providing educational materials are also important aspects of care, but they are not as critical as monitoring for withdrawal symptoms in this immediate scenario.

4. A nurse is providing discharge teaching to a client with heart failure and a prescription for furosemide 20 mg PO twice daily. Which of the following instructions should the nurse include in the teaching?

• A. Monitor for increased blood pressure
• B. Increase intake of high-potassium foods
• C. Expect an increase in swelling in the hands and feet
• D. Take the second dose at bedtime

Correct answer: B

Rationale: The correct answer is B: "Increase intake of high-potassium foods." Furosemide is a loop diuretic that can lead to hypokalemia, a condition characterized by low potassium levels. To prevent this adverse effect, the client should increase their intake of high-potassium foods. Choice A is incorrect because furosemide typically leads to decreased blood pressure, not increased. Choice C is incorrect because furosemide is used to reduce swelling, not increase it. Choice D is incorrect because the second dose of furosemide should be taken in the morning to prevent nocturia.

5. A patient is scheduled for cataract surgery but decides to cancel, stating 'I see just fine.' Which of the following responses should the nurse make?

• A. That’s not a good idea; the surgery is necessary
• B. Share with me more about the thoughts that are concerning you
• C. You should trust your doctor’s advice
• D. You can always reschedule the surgery later

Correct answer: B

Rationale: The correct response is to encourage the patient to share more about their concerns. This approach helps the nurse understand the patient's perspective and allows for a supportive discussion. Choice A is dismissive and does not address the patient's feelings. Choice C may undermine the patient's autonomy and decision-making. Choice D suggests delaying without addressing the patient's current decision.

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