Nursing Elites

1. The nurse is monitoring a client who has just had a thyroidectomy. The client complains of tingling in the fingers and around the mouth. Which of these findings should the nurse assess first?

• A. Calcium level
• B. Chvostek's sign
• C. Trousseau's sign
• D. Serum potassium level

Correct answer: B

Rationale: The correct answer is B, Chvostek's sign. This is a classic sign of hypocalcemia, which can occur after a thyroidectomy due to injury or removal of the parathyroid glands. Hypocalcemia can lead to serious complications like tetany and laryngospasm, necessitating immediate attention. Assessing Chvostek's sign helps in early identification and management of hypocalcemia. Choices A, C, and D are not the priority in this situation. While assessing the calcium level is important for diagnosing hypocalcemia, the immediate concern is to identify clinical signs like Chvostek's sign, which indicate acute hypocalcemia. Trousseau's sign is also related to hypocalcemia but is not the most critical sign to assess first. Serum potassium level, although important for overall electrolyte balance, is not directly related to the client's current symptoms of tingling in the fingers and around the mouth.

2. The client is receiving discharge teaching for heart failure. Which statement made by the client indicates a need for further teaching?

• A. I will weigh myself daily and report any significant weight gain to my healthcare provider.
• B. I will limit my sodium intake to help manage my heart failure.
• C. I will take my medications as prescribed by my healthcare provider.
• D. I will stop taking my medications if I feel better.

Correct answer: D

Rationale: Choice D is the correct answer because stopping medications when feeling better can be harmful in heart failure. It is essential to complete the full course of medication as prescribed by the healthcare provider to effectively manage heart failure. Choices A, B, and C demonstrate good understanding and compliance with heart failure management strategies, such as monitoring weight, restricting sodium intake, and adhering to prescribed medications, respectively.

3. The nurse is caring for a 7-year-old with acute glomerulonephritis (AGN). Findings include moderate edema and oliguria. Serum blood urea nitrogen and creatinine are elevated. What dietary modifications are most appropriate?

• A. Decreased carbohydrates and fat
• B. Decreased sodium and potassium
• C. Increased potassium and protein
• D. Increased sodium and fluids

Correct answer: B

Rationale: The correct answer is 'Decreased sodium and potassium.' In acute glomerulonephritis, managing edema and oliguria is crucial. Reducing sodium and potassium intake helps achieve this by decreasing fluid retention and workload on the kidneys. Choice A, 'Decreased carbohydrates and fat,' is not directly related to managing AGN. Choice C, 'Increased potassium and protein,' is incorrect as increasing potassium can be harmful in kidney conditions. Choice D, 'Increased sodium and fluids,' is also incorrect as it can exacerbate edema and hypertension in AGN.

4. When assessing a client for signs and symptoms of a fluid volume deficit, the nurse would be most concerned with which finding?

• A. Blood pressure of 90/60 mm Hg
• B. Heart rate of 110 beats per minute
• C. Respiratory rate of 24 breaths per minute
• D. Urine output of 30 mL per hour

Correct answer: A

Rationale: Corrected Rationale: A low blood pressure of 90/60 mm Hg is a significant finding indicating fluid volume deficit. In fluid volume deficit, the body tries to compensate by increasing heart rate (choice B) to maintain cardiac output. Respiratory rate (choice C) may increase as a compensatory mechanism, but it is not the primary concern in fluid volume deficit. Urine output (choice D) may decrease in response to fluid volume deficit, but it is a late sign and not the most concerning finding.

5. A client who has received treatment for kidney stones should be reminded to increase intake of which of the following?

• A. Tea
• B. Sodium
• C. Water
• D. Protein

Correct answer: C

Rationale: The correct answer is C: Water. Increasing water intake helps prevent the formation of new kidney stones by diluting the urine. Tea (Choice A) contains oxalates, which can contribute to kidney stone formation. Sodium (Choice B) should be limited to prevent the risk of certain types of kidney stones. Protein (Choice D) intake should be moderate as excessive protein consumption may increase the risk of kidney stones. Therefore, advising the client to increase water intake is the most appropriate recommendation to prevent the recurrence of kidney stones.

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