Nursing Elites

1. The nurse identifies a client's needs and formulates the nursing problem of 'Imbalance nutrition: Less than body requirements, related to mental impairment and decreased intake, as evidenced by increasing confusion and weight loss of more than 30 pounds over the last 6 months.' Which short-term goal is best for this client?

• A. Eat 50% of six small meals each day by the end of the week.
• B. Gain 5 pounds by the end of the month.
• C. Have increased caloric intake.
• D. Show improved nutritional status.

Correct answer: A

Rationale: The correct short-term goal for the client in this scenario is option A: 'Eat 50% of six small meals each day by the end of the week.' This goal is specific, measurable, and time-bound, which aligns with the SMART criteria for goal setting in nursing care. It addresses the client's nutritional needs directly, focusing on increasing meal frequency to meet body requirements and counteract weight loss. Option B, 'Gain 5 pounds by the end of the month,' is not as suitable as it lacks specificity and a short-term timeline, making it less achievable within the immediate care plan. Option C, 'Have increased caloric intake,' is vague and does not provide a measurable target for the client to work towards. Option D, 'Show improved nutritional status,' is a broad goal that lacks the specificity needed for effective short-term goal setting in nursing care. Therefore, option A is the most appropriate choice for this client's short-term goal.

2. A nurse is planning a community event to raise awareness about mental health. Which activity should be included to best engage participants?

• A. lectures by mental health professionals
• B. interactive workshops on stress management
• C. distribution of mental health resources
• D. screenings for depression and anxiety

Correct answer: B

Rationale: Interactive workshops on stress management should be included to best engage participants in a community event about mental health. Unlike lectures by mental health professionals, workshops actively involve participants, allowing for interaction and practical skill-building. While distributing mental health resources and providing screenings for depression and anxiety are important components, interactive workshops offer a more engaging and hands-on approach, empowering individuals with skills they can use to manage their mental health effectively.

3. The healthcare provider is assessing a client who has just returned from hemodialysis. Which finding requires immediate intervention?

• A. Weight gain of 2 pounds.
• B. Dizziness.
• C. Blood pressure of 150/90 mm Hg.
• D. Heart rate of 88 beats per minute.

Correct answer: B

Rationale: Dizziness after hemodialysis can indicate hypovolemia, hypotension, or other complications that require immediate intervention to prevent further deterioration or adverse events. Weight gain of 2 pounds may not be immediately concerning post-hemodialysis. A blood pressure of 150/90 mm Hg is slightly elevated but may not require immediate intervention unless accompanied by symptoms. A heart rate of 88 beats per minute falls within the normal range and may not be an immediate cause for concern after hemodialysis.

4. A client with a history of hypertension is admitted with a blood pressure of 200/120 mm Hg. Which medication should the nurse prepare to administer?

• A. Metoprolol (Lopressor).
• B. Furosemide (Lasix).
• C. Lisinopril (Zestril).
• D. Nitroprusside (Nipride).

Correct answer: D

Rationale: The correct answer is D, Nitroprusside (Nipride). In this scenario of severe hypertension (200/120 mm Hg), a hypertensive emergency is present, requiring rapid reduction of blood pressure. Nitroprusside is a vasodilator that acts quickly to lower blood pressure in such emergencies. Options A, B, and C are incorrect: A) Metoprolol is a beta-blocker that lowers blood pressure but is not indicated for hypertensive emergencies requiring rapid reduction. B) Furosemide is a diuretic that helps with fluid retention but does not rapidly lower blood pressure. C) Lisinopril is an ACE inhibitor used for long-term management of hypertension, not for immediate reduction in hypertensive emergencies.

5. The nurse is preparing a teaching plan for a client who is newly diagnosed with hypothyroidism. Which instruction should the nurse include?

• A. Take levothyroxine (Synthroid) at bedtime.
• B. Increase fiber intake to prevent constipation.
• C. Take the medication on an empty stomach.
• D. Take a double dose if a dose is missed.

Correct answer: C

Rationale: The correct instruction for a client newly diagnosed with hypothyroidism is to take the medication on an empty stomach. This is important because taking levothyroxine on an empty stomach ensures better absorption of the medication. Choice A, taking levothyroxine at bedtime, is incorrect as it does not promote optimal absorption. Choice B, increasing fiber intake to prevent constipation, is important but not the priority when it comes to medication administration. Choice D, taking a double dose if a dose is missed, is dangerous and should never be advised as it can lead to overdose and serious side effects.

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