Nursing Elites

1. The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid retraction, and a staring expression. These findings are consistent with which disorder?

• A. Graves' disease.
• B. Cushing's syndrome.
• C. Addison's disease.
• D. Hypothyroidism.

Correct answer: A

Rationale: The correct answer is A, Graves' disease. The symptoms described in the client are classic manifestations of hyperthyroidism, which is commonly caused by Graves' disease, an autoimmune condition affecting the thyroid. Weight loss, racing heart rate, difficulty sleeping, moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are all indicative of hyperthyroidism. Choice B, Cushing's syndrome, is characterized by weight gain, hypertension, and a rounded face due to excess cortisol. Choice C, Addison's disease, presents with symptoms such as weight loss, fatigue, and hyperpigmentation due to adrenal insufficiency. Choice D, hypothyroidism, typically features symptoms opposite to those described in the client, such as weight gain, bradycardia, and dry skin.

2. A client who has active tuberculosis (TB) is admitted to the medical unit. What action is most important for the nurse to implement?

• A. Wear a gown and gloves.
• B. Have the client wear a mask.
• C. Perform hand hygiene.
• D. Assign the client to a negative air-flow room.

Correct answer: D

Rationale: The correct answer is to assign the client to a negative air-flow room (Choice D). Active tuberculosis requires implementation of airborne precautions, including isolating the client in a negative pressure air-flow room to prevent the spread of the infection to others. Choice A (Wear a gown and gloves) is important for standard precautions but does not address the specific airborne precautions needed for tuberculosis. Choice B (Have the client wear a mask) may help reduce the spread of respiratory droplets but does not provide adequate protection for healthcare workers or other patients. Choice C (Perform hand hygiene) is essential for infection control but is not the most critical action when dealing with an airborne infection like tuberculosis.

3. The public health nurse is evaluating resources in a rural community. Which healthcare resource is most important for the community?

• A. family planning center
• B. accessibility to trauma care
• C. annual health fair
• D. weather-related disaster plan

Correct answer: B

Rationale: In rural areas, accessibility to trauma care is the most critical healthcare resource due to the longer emergency response times. Trauma care can be life-saving in situations where immediate medical attention is required for severe injuries. The other options, such as a family planning center, annual health fair, and weather-related disaster plan, are important but not as crucial as trauma care in addressing urgent health needs in a rural community.

4. A client is receiving atenolol (Tenormin) 25 mg PO after a myocardial infarction. The nurse determines the client's apical pulse is 65 beats per minute. What action should the nurse take next?

• A. Hold the medication.
• B. Call the healthcare provider.
• C. Administer the medication.
• D. Check the blood pressure.

Correct answer: C

Rationale: The correct action for the nurse to take next is to administer the medication. Atenolol is a beta-blocker commonly used post-myocardial infarction to reduce the workload of the heart. The client's apical pulse of 65 beats per minute is within the acceptable range after a myocardial infarction. Holding the medication or calling the healthcare provider is not necessary in this scenario as the pulse rate is appropriate for administering atenolol. Checking the blood pressure is not the priority in this situation, as the focus should be on the heart rate when administering atenolol.

5. A client with a history of alcohol abuse is admitted with acute pancreatitis. Which laboratory result requires immediate intervention?

• A. Amylase of 120 U/L.
• B. Lipase of 150 U/L.
• C. Calcium of 8.5 mg/dL.
• D. Blood glucose of 250 mg/dL.

Correct answer: D

Rationale: The correct answer is D, 'Blood glucose of 250 mg/dL.' In a client with acute pancreatitis, elevated blood glucose levels can indicate poor control of diabetes or stress response from the acute illness. Immediate intervention is necessary to prevent complications like worsening pancreatitis, infections, or other metabolic issues. Choices A and B, 'Amylase of 120 U/L' and 'Lipase of 150 U/L,' are commonly elevated in pancreatitis but do not require immediate intervention unless significantly elevated. Choice C, 'Calcium of 8.5 mg/dL,' is within the normal range and not a priority in this scenario.

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