Nursing Elites

1. After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, 'I have had it with that client. I just can't do anything that pleases him. I'm not going in there again.' The nurse should respond by saying

• A. He has a lot of problems. You need to have patience with him.
• B. I will talk with him and try to figure out what to do.
• C. He is scared and taking it out on you. Let's talk to figure out what to do.
• D. Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day.

Correct answer: C

Rationale: The correct response is to acknowledge the UAP's feelings while exploring the client's behavior. By stating, 'He is scared and taking it out on you. Let's talk to figure out what to do,' the nurse shows empathy and readiness to address the situation collaboratively. This approach helps maintain a therapeutic environment for both the UAP and the client. Choices A and D are dismissive and do not address the underlying issue or provide support. Choice B, while showing willingness to intervene, lacks the understanding of the client's potential fear and does not address the UAP's feelings.

2. A client with diabetes mellitus reports feeling shaky, dizzy, and sweaty. The nurse checks the client's blood glucose level and it is 55 mg/dL. What is the nurse's next action?

• A. Give the client a glucagon injection
• B. Encourage the client to eat a high-protein snack
• C. Administer 15 grams of a fast-acting carbohydrate
• D. Recheck the blood glucose level in 15 minutes

Correct answer: C

Rationale: A blood glucose level of 55 mg/dL indicates hypoglycemia, which should be treated with a fast-acting carbohydrate to quickly raise the blood sugar. Administering 15 grams of a fast-acting carbohydrate, such as glucose tablets or juice, is the appropriate initial intervention for hypoglycemia. Giving a glucagon injection is reserved for severe cases or when the client is unconscious. Encouraging the client to eat a high-protein snack is not appropriate for treating acute hypoglycemia, as it is a slower-acting form of glucose. Rechecking the blood glucose level is important but should occur after providing immediate treatment to raise the blood sugar level.

3. When caring for a client with acute respiratory distress syndrome (ARDS), why does the nurse elevate the head of the bed 30 degrees?

• A. To reduce abdominal pressure on the diaphragm
• B. To promote oxygenation by improving lung expansion
• C. To encourage use of accessory muscles for breathing
• D. To drain secretions and prevent aspiration

Correct answer: D

Rationale: Elevating the head of the bed in a client with acute respiratory distress syndrome (ARDS) is essential to drain secretions and prevent aspiration. This position helps facilitate the removal of secretions from the airways, reducing the risk of aspiration pneumonia. Choices A, B, and C are incorrect as the primary reason for elevating the head of the bed in ARDS is to assist with secretion drainage and prevent complications associated with aspiration.

4. A client with cirrhosis is admitted with ascites and peripheral edema. Which intervention should the nurse implement first?

• A. Elevate the legs to reduce swelling.
• B. Restrict fluids to reduce fluid overload.
• C. Administer furosemide to reduce fluid overload.
• D. Monitor the client's intake and output.

Correct answer: C

Rationale: Administering a diuretic like furosemide is the priority intervention for a client with cirrhosis, ascites, and peripheral edema. Furosemide helps reduce fluid overload by promoting diuresis. Elevating the legs may provide some symptomatic relief but does not address the underlying issue of fluid overload. Restricting fluids is not appropriate initially as the client needs proper hydration while managing fluid balance. Monitoring intake and output is important but not the first action to address the immediate fluid overload in this client.

5. The nurse is evaluating the laboratory reports of a client with hypothyroidism. The nurse would expect which of the following laboratory values?

• A. Increased TSH
• B. Increased thyroxine (T4)
• C. Decreased TSH
• D. Decreased T3

Correct answer: A

Rationale: The correct answer is A: Increased TSH. In hypothyroidism, the thyroid gland is underactive, leading to low levels of thyroid hormones. As a compensatory mechanism, the pituitary gland releases more thyroid-stimulating hormone (TSH) to try to stimulate the thyroid gland to produce more hormones. Therefore, increased TSH levels are expected in hypothyroidism. Choice B is incorrect because in hypothyroidism, thyroxine (T4) levels are usually decreased, not increased. Choice C is incorrect as hypothyroidism is characterized by increased TSH levels, not decreased. Choice D is also incorrect because in hypothyroidism, T3 levels may be decreased, but TSH is a more sensitive indicator for diagnosis.

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