Nursing Elites

1. The client is being discharged after a concussion. Which of the following symptoms should be reported?

• A. Difficulty waking up
• B. Headache (3/10 on the pain scale)
• C. Bruising on knees and elbows
• D. Achy feeling all over

Correct answer: A

Rationale: The correct answer is 'Difficulty waking up' because it indicates a change in consciousness, which is a concerning symptom following a concussion. Reporting this symptom is crucial as it may signify a more severe head injury. 'Headache (3/10 on the pain scale)' may be common after a concussion but is not as urgent as a change in consciousness. 'Bruising on knees and elbows' is likely unrelated to the concussion and not a priority for reporting. 'Achy feeling all over' is a vague symptom and not specific to a concerning change in the client's condition post-concussion.

2. What do the following ABG values indicate: pH 7.38, PO2 78 mmHg, PCO2 36mmHg, and HCO3 24 mEq/L?

• A. metabolic alkalosis
• B. homeostasis
• C. respiratory acidosis
• D. respiratory alkalosis

Correct answer: B

Rationale: The correct answer is 'homeostasis.' These ABG values fall within normal ranges, indicating a state of balance in the body's acid-base levels. Choices A, C, and D are incorrect as the ABG values provided do not point towards metabolic alkalosis, respiratory acidosis, or respiratory alkalosis. Instead, the values reflect a state of equilibrium where pH, PO2, PCO2, and HCO3 levels are within the normal range.

3. Which of the following nursing diagnoses is most appropriate for the client experiencing acute pancreatitis?

• A. Confusion
• B. Latex Allergy
• C. Acute Pain
• D. Constipation

Correct answer: C

Rationale: Acute Pain is the most appropriate nursing diagnosis for a client experiencing acute pancreatitis because it is a common symptom associated with this condition. Pancreatitis often presents with severe abdominal pain that may radiate to the back. Confusion, Latex Allergy, and Constipation are not typically associated with acute pancreatitis. Confusion may occur in severe cases of pancreatitis with complications, but acute pain is the priority nursing diagnosis due to its prevalence and impact on the client's well-being.

4. A nurse is instructing a patient about the warning signs of Digitalis side effects. Which of the following side effects should the nurse tell the patient are sometimes associated with excessive levels of Digitalis?

• A. Seizures
• B. Muscle weakness
• C. Depression
• D. Anxiety

Correct answer: B

Rationale: The correct answer is 'Muscle weakness.' Palpitations and muscle weakness are commonly associated with excessive levels of Digitalis. Seizures, depression, and anxiety are not typically linked to Digitalis toxicity. Seizures could be more related to other medications or conditions, while depression and anxiety are not commonly reported side effects of Digitalis.

5. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?

• A. Hypertension
• B. Hyperkalemia
• C. Bradycardia
• D. Arthralgia

Correct answer: C

Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.

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