Nursing Elites

1. An adult female client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. After starting medication therapy, the nurse notices the client has more energy, is giving away her belongings, and has an elevated mood. Which intervention is best for the nurse to implement?

• A. Support the client by telling her what wonderful progress she is making.
• B. Ask the client if she has had any recent thoughts of harming herself.
• C. Reassure the client that the antidepressant drugs are apparently effective.
• D. Tell the client to keep her belongings because she will need them at discharge.

Correct answer: B

Rationale: When a client with major depressive disorder shows signs of increased energy, giving away belongings, and an elevated mood, it could indicate a shift towards suicidal behavior. Therefore, the best intervention for the nurse is to ask the client if she has had any recent thoughts of harming herself. This is crucial to assess the client's risk for suicide and provide necessary interventions. Choices A, C, and D are incorrect because they do not address the potential risk of harm to the client and do not prioritize the immediate assessment required in this situation.

2. The nurse is assessing a client with left-sided heart failure. Which assessment finding requires immediate intervention?

• A. Jugular venous distention
• B. Shortness of breath
• C. Crackles in the lungs
• D. Peripheral edema

Correct answer: C

Rationale: In a client with left-sided heart failure, crackles in the lungs are a critical assessment finding that necessitates immediate intervention. Crackles indicate pulmonary congestion, a sign of worsening heart failure that requires prompt attention to prevent respiratory distress. Jugular venous distention, shortness of breath, and peripheral edema are also common in heart failure, but crackles specifically point to pulmonary involvement and the urgent need for intervention.

3. When a client with a history of atrial fibrillation is admitted with a new onset of confusion, which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: The correct answer is an Electrocardiogram (ECG). When a client with a history of atrial fibrillation presents with new-onset confusion, an ECG is crucial to assess for cardiac ischemia, which could be a potential cause of the confusion. A chest X-ray (Choice B) is not typically the first-line diagnostic test for evaluating confusion in a client with atrial fibrillation. Arterial blood gases (ABGs) (Choice C) are more useful in assessing oxygenation and acid-base balance rather than the cause of confusion in this scenario. While an echocardiogram (Choice D) provides valuable information about cardiac structure and function, it is usually not the initial diagnostic test needed in the evaluation of acute confusion in a client with atrial fibrillation.

4. A client with end-stage renal disease (ESRD is scheduled for hemodialysis. Which laboratory value should the nurse monitor closely before the procedure?

• A. Serum creatinine
• B. Serum potassium
• C. Serum sodium
• D. Hemoglobin

Correct answer: B

Rationale: Before hemodialysis in a client with end-stage renal disease (ESRD), monitoring serum potassium closely is crucial. ESRD patients are at risk of hyperkalemia, which can lead to severe cardiac complications. Checking serum potassium levels helps in assessing and managing this electrolyte imbalance. Serum creatinine (Choice A) is a marker of kidney function but is not the most critical value to monitor before hemodialysis. Serum sodium (Choice C) may be affected in renal disease, but potassium is a more crucial electrolyte to monitor. Hemoglobin (Choice D) is essential for assessing anemia in ESRD but is not the primary focus before hemodialysis.

5. The healthcare provider should observe most closely for drug toxicity when a client receives a medication that has which characteristic?

• A. Low bioavailability
• B. Rapid onset of action
• C. Short half-life
• D. Narrow therapeutic index

Correct answer: D

Rationale: The correct answer is D, narrow therapeutic index. Narrow therapeutic index (NTI) drugs are defined as those drugs where small differences in dose or blood concentration may lead to serious therapeutic failures or adverse drug reactions. Choices A, B, and C are not directly related to the risk of drug toxicity. Low bioavailability (Choice A) refers to the amount of drug that enters the bloodstream unchanged after administration. Rapid onset of action (Choice B) and short half-life (Choice C) are characteristics related to drug effectiveness and metabolism but do not necessarily indicate a higher risk of drug toxicity.

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