Nursing Elites

1. What is the best initial action when a patient presents with confusion?

• A. Administer IV fluids
• B. Perform a neurological assessment
• C. Administer electrolytes
• D. Prepare for a CT scan

Correct answer: B

Rationale: When a patient presents with confusion, the best initial action is to perform a neurological assessment. This assessment helps in identifying potential causes of confusion such as neurological issues, infections, metabolic abnormalities, or medication side effects. Administering IV fluids (Choice A) may be necessary based on assessment findings, but it is not the first step. Administering electrolytes (Choice C) would also depend on the assessment results. Preparing for a CT scan (Choice D) may be indicated later in the diagnostic process but is not the initial action when a patient presents with confusion.

2. A nurse is providing teaching to a client who has a new prescription for atorvastatin. Which of the following instructions should the nurse include?

• A. Avoid drinking grapefruit juice while taking this medication.
• B. Take this medication with food to prevent stomach upset.
• C. You should take this medication at bedtime.
• D. You should take this medication on an empty stomach.

Correct answer: A

Rationale: The correct answer is A: 'Avoid drinking grapefruit juice while taking this medication.' Grapefruit juice can increase the risk of toxicity when taken with atorvastatin. Choice B is incorrect because atorvastatin should be taken without regard to meals. Choice C is incorrect because atorvastatin can be taken at any time of the day. Choice D is incorrect because atorvastatin does not need to be taken on an empty stomach.

3. A nurse is assessing a client who has gastroesophageal reflux disease (GERD). Which of the following findings should the nurse expect?

• A. Abdominal distention
• B. Burning sensation in the chest
• C. Constipation
• D. Frequent belching

Correct answer: B

Rationale: The correct answer is B: Burning sensation in the chest. A burning sensation in the chest is a classic symptom of gastroesophageal reflux disease (GERD). Abdominal distention (Choice A) is not typically associated with GERD; it is more commonly seen in conditions like bowel obstruction. Constipation (Choice C) is not a hallmark symptom of GERD, as it is more related to gastrointestinal motility issues. Frequent belching (Choice D) can occur with GERD, but it is not as specific or characteristic as the burning sensation in the chest.

4. What is the most important assessment for a patient post-op to monitor for complications?

• A. Monitor vital signs
• B. Monitor the surgical site
• C. Check blood glucose levels
• D. Check for abnormal breath sounds

Correct answer: A

Rationale: The correct answer is to monitor vital signs. Post-operative patients need close monitoring of their vital signs to detect early signs of complications such as changes in blood pressure, heart rate, temperature, and respiratory rate. While monitoring the surgical site is also important for signs of infection, assessing vital signs takes precedence as it provides immediate information about the patient's overall condition. Checking blood glucose levels may be essential for specific patients but is not the primary assessment for monitoring post-op complications. Checking for abnormal breath sounds is important but falls secondary to monitoring vital signs as it indicates respiratory issues rather than providing a comprehensive assessment of the patient's condition.

5. A nurse is assessing a school-age child with a urinary tract infection. Which symptom should the nurse expect?

• A. Periorbital edema.
• B. Decreased frequency of urination.
• C. Enuresis.
• D. Diarrhea.

Correct answer: C

Rationale: Enuresis is a common symptom of urinary tract infections in school-age children. It is often a presenting symptom due to irritation of the bladder. Periorbital edema (Choice A) is more indicative of conditions like nephrotic syndrome or renal disorders. Decreased frequency of urination (Choice B) is not typically associated with urinary tract infections. Diarrhea (Choice D) is not a common symptom of urinary tract infections but may occur due to other reasons like gastrointestinal infections.

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