Nursing Elites

1. After multiple attempts to stop drinking, an adult male is admitted to the medical intensive care unit (MICU) with delirium tremens. He is tachycardic, diaphoretic, restless, and disoriented. Which finding indicates a life-threatening condition?

• A. Widening QRS complexes and flat T waves
• B. Tachycardia and elevated blood pressure
• C. Restlessness and anxiety
• D. Diaphoresis and dehydration

Correct answer: A

Rationale: The correct answer is A: Widening QRS complexes and flat T waves. In the context of an adult male with delirium tremens and symptoms like tachycardia, diaphoresis, restlessness, and disorientation, the presence of widening QRS complexes and flat T waves on an ECG suggests severe electrolyte imbalance, particularly hypokalemia. This severe electrolyte imbalance can lead to life-threatening arrhythmias such as ventricular tachycardia or fibrillation. Tachycardia and elevated blood pressure (choice B) can be expected in delirium tremens but do not directly indicate a life-threatening condition as widening QRS complexes and flat T waves do. Restlessness and anxiety (choice C) are common symptoms of delirium tremens but do not specifically signify a life-threatening condition. Diaphoresis and dehydration (choice D) are also common in delirium tremens but do not directly point towards a life-threatening electrolyte imbalance as widening QRS complexes and flat T waves do.

2. The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which clinical finding requires immediate intervention?

• A. Increased fatigue
• B. Elevated blood pressure
• C. Headache
• D. Elevated hemoglobin

Correct answer: A

Rationale: The correct answer is A, 'Increased fatigue.' In a client with CKD receiving erythropoietin therapy, increased fatigue can be a sign of polycythemia, a condition characterized by an elevated red blood cell count. This can lead to increased blood viscosity and raise the risk of thromboembolic events, necessitating immediate intervention. Elevated blood pressure (choice B) is a common concern in CKD but does not require immediate intervention in this context. Headache (choice C) may be related to elevated blood pressure but is not the most critical finding requiring immediate attention. Elevated hemoglobin (choice D) is an expected outcome of erythropoietin therapy and does not require immediate intervention unless excessively high.

3. A client with hyperthyroidism is admitted to the postoperative unit after subtotal thyroidectomy. Which of the client's serum laboratory values requires intervention by the nurse?

• A. Total calcium 5.0 mg/dL.
• B. Serum sodium 140 mEq/L.
• C. Serum potassium 4.0 mEq/L.
• D. Serum glucose 90 mg/dL.

Correct answer: A

Rationale: The correct answer is A. A calcium level of 5.0 mg/dL is critically low and could indicate hypoparathyroidism, a possible complication after thyroidectomy. Low calcium levels can lead to tetany, seizures, and cardiac dysrhythmias, requiring immediate intervention. Choices B, C, and D fall within the normal range and do not require immediate intervention in this scenario.

4. The nurse is teaching a male client with multiple sclerosis how to empty his bladder using the Crede Method. When performing a return demonstration, the client applies pressure to the umbilical areas of his abdomen. What instruction should the nurse provide?

• A. Stroke the inner thigh below the perineum to initiate urinary flow
• B. Contract, hold, and then relax the pubococcygeal muscle
• C. Pour warm water over the external sphincter at the distal glans
• D. Apply downward manual pressure at the suprapubic regions

Correct answer: D

Rationale: The client is applying pressure in the wrong region (umbilical area) and should be instructed to apply pressure at the suprapubic area. Applying downward manual pressure at the suprapubic region helps in emptying the bladder effectively by assisting in pushing the urine out through the urethra. Choices A, B, and C are incorrect because they do not address the specific issue of applying pressure to help empty the bladder using the Crede Method.

5. In preparing assignments for the shift, which client is best for the charge nurse to assign to a practical nurse (PN)?

• A. An older client who fell yesterday and is now complaining of diplopia.
• B. An adult newly diagnosed with type 1 diabetes and high cholesterol.
• C. A client with pancreatic cancer who is experiencing intractable pain.
• D. An older client post-stroke who is aphasic with right-sided hemiplegia.

Correct answer: D

Rationale: The best client for the charge nurse to assign to a practical nurse (PN) is an older client post-stroke who is aphasic with right-sided hemiplegia. This client is stable and suitable for care by a PN under supervision. Choices A, B, and C present clients with more complex and acute conditions that would require a higher level of nursing expertise and intervention.

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