Nursing Elites

1. The client has undergone a thyroidectomy, and the nurse is providing care. Which assessment finding requires immediate intervention?

• A. Hoarseness and a sore throat.
• B. Difficulty swallowing.
• C. Numbness and tingling around the mouth.
• D. Temperature of 100.2°F (37.9°C).

Correct answer: C

Rationale: Numbness and tingling around the mouth can indicate hypocalcemia, a common complication post-thyroidectomy due to inadvertent parathyroid gland removal. Immediate intervention is required to prevent severe hypocalcemia manifestations like tetany or seizures. Hoarseness and a sore throat are common after a thyroidectomy due to surgical trauma and irritation to the vocal cords, not requiring immediate intervention. Difficulty swallowing can be expected due to postoperative swelling or edema, but it should be monitored closely. A temperature of 100.2°F is a mild fever and may be a normal postoperative response, not necessitating immediate intervention unless accompanied by other concerning symptoms.

2. A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?

• A. NSAIDs
• B. Alendronate
• C. Iron sulfate
• D. Calcium channel blocker

Correct answer: D

Rationale: In this case, the least likely contributor to the condition described is the calcium channel blocker. NSAIDs, alendronate, and iron sulfate have been associated with pill-induced esophagitis, which can present with symptoms like odynophagia and erosions or ulcers on imaging studies. Pill-induced esophagitis is often due to factors like inadequate water intake with the medication, being in a supine position, or underlying motility disorders. Discontinuation of the offending medication typically leads to rapid resolution of esophageal injury. Acid-suppressive therapy may be used to prevent reflux-related damage.

3. A client with chronic obstructive pulmonary disease (COPD) is experiencing respiratory distress. Which intervention should the nurse implement first?

• A. Administer bronchodilators as prescribed.
• B. Encourage pursed-lip breathing.
• C. Position the client in a high Fowler's position.
• D. Obtain a stat arterial blood gas (ABG) sample.

Correct answer: C

Rationale: In a client with COPD experiencing respiratory distress, the priority intervention should be to position the client in a high Fowler's position. This position helps optimize lung expansion, improve oxygenation, and reduce the work of breathing. Administering bronchodilators and encouraging pursed-lip breathing are important interventions but positioning the client to enhance respiratory function takes precedence in this situation. Obtaining an ABG sample may provide valuable information but is not the initial priority when addressing respiratory distress.

4. A client with acute pancreatitis is admitted to the hospital. What is the priority nursing intervention for this client?

• A. Administering oral pancreatic enzymes
• B. Encouraging a high-protein diet
• C. Maintaining NPO status and administering IV fluids
• D. Providing a low-fat diet

Correct answer: C

Rationale: The priority nursing intervention for a client with acute pancreatitis is to maintain NPO (nothing by mouth) status and administer IV fluids. This approach helps rest the pancreas, decrease pancreatic stimulation, and prevent further exacerbation of the condition. By withholding oral intake and providing IV fluids, the pancreas is given the opportunity to recover and inflammation can be reduced. This intervention is crucial in the acute phase of pancreatitis to support the healing process and prevent complications.

5. The client is receiving intravenous (IV) morphine for pain control. Which assessment finding requires the most immediate intervention?

• A. Drowsiness.
• B. Itching.
• C. Nausea.
• D. Respiratory rate of 8 breaths per minute.

Correct answer: D

Rationale: A respiratory rate of 8 breaths per minute indicates severe respiratory depression, a life-threatening side effect of opioid therapy. Immediate intervention is crucial to prevent respiratory failure. Monitoring and managing respiratory status are critical in clients receiving opioids to prevent adverse events. Drowsiness, itching, and nausea are common side effects of morphine but are not as immediately life-threatening as severe respiratory depression.

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