Nursing Elites

1. The nurse is caring for a client with a diagnosis of bipolar disorder who is taking lithium. What is the most important information the nurse should provide?

• A. Take the medication on an empty stomach.
• B. Monitor sodium intake.
• C. Report any signs of weight gain.
• D. Avoid excessive caffeine intake.

Correct answer: B

Rationale: The correct answer is B: 'Monitor sodium intake.' Sodium levels can affect lithium levels in the body, so it is crucial to maintain a consistent sodium intake to prevent toxicity or subtherapeutic levels. Option A is incorrect because lithium is usually recommended to be taken on an empty stomach to enhance absorption. Option C, reporting signs of weight gain, is relevant but not as critical as monitoring sodium intake. Option D, avoiding excessive caffeine intake, is important for some individuals but not as essential as monitoring sodium levels when taking lithium.

2. A client is receiving dexamethasone (Decadron). What symptoms should the nurse recognize as Cushingoid side effects?

• A. Moon face, slow wound healing, muscle wasting, sodium and water retention
• B. Tachycardia, hypertension, weight loss, heat intolerance, nervousness, restlessness, tremor
• C. Bradycardia, weight gain, cold intolerance, myxedema facies and periorbital edema
• D. Hyperpigmentation, hyponatremia, hyperkalemia, dehydration, hypotension

Correct answer: A

Rationale: Cushingoid side effects are characteristic of excess corticosteroid use, such as dexamethasone. These include moon face (rounding of the face), slow wound healing, muscle wasting, and sodium and water retention. Options B, C, and D describe symptoms that are not typically associated with Cushingoid side effects. Tachycardia, hypertension, weight loss, heat intolerance, nervousness, restlessness, tremor (Option B) are not typical of Cushingoid effects, while bradycardia, weight gain, cold intolerance, myxedema facies, and periorbital edema (Option C) are more indicative of hypothyroidism. Hyperpigmentation, hyponatremia, hyperkalemia, dehydration, and hypotension (Option D) are not classical features of Cushingoid side effects.

3. The mother of an 8-year-old boy tells the nurse that he fell out of a tree and hurt his arm and shoulder. Which assessment finding is the most significant indicator of possible child abuse?

• A. The child looks at the floor when answering the nurse's questions
• B. The mother's version of the injury is different from the child's version
• C. The child has several abrasions on the chest and legs
• D. The mother refuses to answer questions about family history

Correct answer: B

Rationale: In cases of possible child abuse, discrepancies between the accounts given by the child and the parent are critical indicators. This inconsistency could suggest that the injury was not accidental and may be a result of abuse. Looking at the floor while answering questions or having abrasions on the body can be concerning but are not as direct indicators of abuse as conflicting stories between the child and the parent.

4. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with shortness of breath. What is the priority nursing intervention?

• A. Administer a high-flow oxygen mask.
• B. Position the client in a high-Fowler's position.
• C. Provide a high-carbohydrate diet.
• D. Encourage the client to cough and deep breathe.

Correct answer: B

Rationale: The priority nursing intervention for a client with COPD experiencing shortness of breath is to position the client in a high-Fowler's position. This position helps improve lung expansion and breathing by reducing respiratory effort. Administering a high-flow oxygen mask (Choice A) may be necessary but is not the priority intervention. Providing a high-carbohydrate diet (Choice C) is not directly related to managing acute shortness of breath in COPD. Encouraging the client to cough and deep breathe (Choice D) is helpful for airway clearance but is not the priority intervention when the client is in distress with acute shortness of breath.

5. The nurse is caring for a client who is 4 hours post-operative from abdominal surgery. The client is complaining of severe pain. What is the nurse's first action?

• A. Reassess the pain and its characteristics
• B. Administer prescribed pain medication
• C. Notify the surgeon
• D. Encourage the use of relaxation techniques

Correct answer: A

Rationale: The correct first action for the nurse to take when a post-operative client complains of severe pain is to reassess the pain and its characteristics. Reassessment is crucial to understand the nature and intensity of the pain, which will guide the nurse in providing appropriate interventions. Administering pain medication may be necessary but should only be done after reassessment to ensure the right medication and dose are given. Notifying the surgeon may be required in certain situations, but reassessment of pain should precede this action. Encouraging relaxation techniques is not the priority when a client is experiencing severe pain post-operatively.

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