Nursing Elites

1. The client had a thyroidectomy 24 hours ago and reports experiencing numbness and tingling of the face. Which intervention should the nurse implement?

• A. Open and prepare the tracheostomy kit.
• B. Inspect the neck for an increase in swelling.
• C. Monitor for the presence of Chvostek's sign.
• D. Assess lung sounds for laryngeal stridor.

Correct answer: C

Rationale: The correct answer is C: Monitor for the presence of Chvostek's sign. Chvostek's sign is a clinical indicator of hypocalcemia, a common complication after thyroidectomy. Numbness and tingling around the face are associated with hypocalcemia due to potential damage to the parathyroid glands during surgery, leading to decreased calcium levels. Inspecting the neck for swelling (choice B) is important but does not directly address the presenting symptoms. Opening and preparing the tracheostomy kit (choice A) is not necessary based on the client's current symptoms. Assessing lung sounds for laryngeal stridor (choice D) is not directly related to the client's reported numbness and tingling of the face.

2. After three days of persistent epigastric pain, a female client presents to the clinic. She has been taking oral antacids without relief. Her vital signs are heart rate 122 beats/minute, respirations 16 breaths/minute, oxygen saturation 96%, and blood pressure 116/70. The nurse obtains a 12-lead electrocardiogram (ECG). Which assessment finding is most critical?

• A. Irregular pulse rhythm
• B. Bile-colored emesis
• C. ST elevation in three leads
• D. Complaint of radiating jaw pain

Correct answer: C

Rationale: ST elevation in three leads is a critical finding that suggests myocardial infarction, requiring immediate attention. This finding indicates ischemia or injury to the heart muscle. Choices A, B, and D are not as critical in this scenario. Irregular pulse rhythm may be concerning but does not indicate an immediate life-threatening condition like myocardial infarction. Bile-colored emesis and complaint of radiating jaw pain are relevant but not as indicative of a myocardial infarction as ST elevation in three leads.

3. A client with chronic renal failure is receiving erythropoietin therapy. The nurse should assess the client for which of the following side effects?

• A. Hypotension.
• B. Hypertension.
• C. Hyperglycemia.
• D. Hypercalcemia.

Correct answer: B

Rationale: The correct answer is B: Hypertension. Erythropoietin therapy can lead to an increase in blood pressure, making hypertension a common side effect that the nurse should closely monitor. Hypotension (choice A) is not typically associated with erythropoietin therapy. Hyperglycemia (choice C) and hypercalcemia (choice D) are not commonly linked to erythropoietin therapy in clients with chronic renal failure, making them incorrect choices.

4. A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.)

• A. You will not need vascular access to perform PD.
• B. There is less restriction of protein and fluids.
• C. You have flexible scheduling for the exchanges.
• D. All of the above

Correct answer: D

Rationale: The correct answer is D, as all the statements are accurate advantages of peritoneal dialysis (PD). Peritoneal dialysis does not require vascular access, offers less restriction on protein and fluids, and provides flexibility in scheduling for the exchanges. Choice A is correct because one of the advantages of PD is not needing vascular access, which is required in hemodialysis. Choice B is correct because PD allows for less dietary restriction compared to hemodialysis. Choice C is correct because PD allows for flexible scheduling of exchanges, providing more independence to the individual undergoing treatment.

5. A CD4+ lymphocyte count is performed on a client infected with HIV. The results of the test indicate a CD4+ count of 450 cells/L. The nurse interprets this test result as indicating:

• A. Improvement in the client
• B. The need for antiretroviral therapy
• C. The need to discontinue antiretroviral therapy
• D. An effective response to the treatment for HIV

Correct answer: B

Rationale: A CD4+ count of 450 cells/L is below the normal range (500-1600 cells/mcL), indicating a decline in immune function in the client. Antiretroviral therapy is recommended when the CD4+ count falls below 500 cells/mcL or below 25%, or when the client displays symptoms of HIV. Therefore, the interpretation of this test result suggests that the client requires antiretroviral therapy to manage the HIV infection. Choices A, C, and D are incorrect because a CD4+ count of 450 cells/L does not signify improvement, discontinuation of therapy, or an effective response to treatment for HIV.

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