Nursing Elites

1. The nurse is preparing a discharge teaching plan for a liver transplant client. Which instruction is most important to include in this plan?

• A. Ensure daily follow-up with the healthcare provider
• B. Take immunosuppressant medications as prescribed
• C. Avoid crowds for the first two months after surgery
• D. Return to work in three months

Correct answer: B

Rationale: The most critical instruction to include in the discharge teaching plan for a liver transplant client is to take immunosuppressant medications as prescribed. This is vital to prevent organ rejection and ensure the success of the transplant. While ensuring daily follow-up with the healthcare provider is important for monitoring progress, avoiding crowds for the first two months after surgery helps reduce the risk of infections but is not as crucial as medication adherence. Returning to work in three months is a consideration but not the most important aspect immediately post-transplant.

2. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past 12 days. Which assessment finding requires immediate follow-up?

• A. Increased appetite
• B. Describes life without purpose
• C. Exhibits mood swings
• D. Complains of insomnia

Correct answer: B

Rationale: An adolescent expressing 'life without purpose' after taking duloxetine (Cymbalta) may be indicating suicidal ideation, which requires immediate attention. The initial period of antidepressant treatment can increase the risk of suicidal thoughts, especially in younger populations. Increased appetite (Choice A) is a common side effect of duloxetine and may not require immediate follow-up. Mood swings (Choice C) and insomnia (Choice D) are also possible side effects of the medication but are not as urgent as addressing suicidal ideation.

3. The nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease (COPD). Which intervention is most important to promote effective breathing?

• A. Encourage diaphragmatic breathing
• B. Increase the client's oxygen flow rate
• C. Have the client perform range of motion exercises
• D. Place the client in a supine position

Correct answer: A

Rationale: Encouraging diaphragmatic breathing is crucial in clients with COPD as it helps improve lung expansion and oxygen exchange, promoting more effective breathing. This intervention aids in reducing dyspnea and enhancing ventilation. Increasing the client's oxygen flow rate may not be appropriate and can potentially worsen hypercapnia in individuals with COPD. Performing range of motion exercises and placing the client in a supine position do not directly address the breathing difficulties associated with COPD exacerbation.

4. A client with osteoarthritis is prescribed acetaminophen. What is the most important teaching the nurse should provide?

• A. Take the medication with food to improve absorption.
• B. Avoid taking other pain medications to prevent liver damage.
• C. Take acetaminophen on an empty stomach to prevent stomach upset.
• D. Monitor liver function tests regularly to detect any liver damage.

Correct answer: B

Rationale: The correct answer is B. Acetaminophen can cause liver damage if taken in excessive amounts or in combination with other medications containing acetaminophen. Clients should be advised to avoid other pain medications to prevent liver toxicity. Choice A is incorrect because acetaminophen is usually taken with or without food, not specifically on an empty stomach. Choice C is incorrect because taking acetaminophen with food can help prevent stomach upset. Choice D is incorrect because while monitoring liver function tests is important for long-term acetaminophen use, the most crucial teaching is to avoid other pain medications to prevent liver damage.

5. A client with a history of chronic kidney disease presents with increased swelling and shortness of breath. What is the nurse's priority action?

• A. Administer oxygen at 2 liters per nasal cannula.
• B. Administer a diuretic as prescribed.
• C. Monitor the client's vital signs.
• D. Reposition the client to improve lung expansion.

Correct answer: B

Rationale: The correct answer is to administer a diuretic as prescribed. In a client with chronic kidney disease experiencing increased swelling and shortness of breath, the priority action is to address fluid retention. Administering a diuretic helps reduce fluid overload, alleviate symptoms, and prevent complications associated with fluid buildup. Option A is not the priority in this situation as addressing fluid retention takes precedence over providing oxygen. While monitoring vital signs is important, it is secondary to addressing the underlying cause of symptoms. Repositioning the client may help with comfort but does not directly address the fluid overload seen in chronic kidney disease.

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