Nursing Elites

1. While performing a skin inspection for a female adult client, the nurse observes a rash that is well circumscribed, has silvery scales and plaques, and is located on the elbows and knees. These assessment findings are likely to indicate which condition?

• A. Tinea corporis
• B. Herpes zoster
• C. Psoriasis
• D. Drug reaction

Correct answer: C

Rationale: The correct answer is C, Psoriasis. Psoriasis commonly presents with well-circumscribed, silvery scales and plaques, typically found on extensor surfaces like elbows and knees. Tinea corporis (A) presents as a circular rash, herpes zoster (B) presents as a painful rash following a dermatomal pattern, and drug reactions (D) have variable presentations not specific to elbows and knees with silvery scales and plaques.

2. A client with a history of myocardial infarction is admitted with chest pain. Which laboratory value should the nurse monitor closely?

• A. White blood cell count
• B. Serum creatinine
• C. Troponin level
• D. Hemoglobin level

Correct answer: C

Rationale: The correct answer is C: Troponin level. Troponin levels should be closely monitored in a client with chest pain and a history of myocardial infarction to assess for ongoing myocardial injury. Troponin is a specific marker for myocardial damage. Monitoring white blood cell count (choice A) is not directly related to myocardial infarction. Serum creatinine (choice B) is more indicative of renal function rather than cardiac status. Hemoglobin level (choice D) is important but does not directly reflect ongoing myocardial injury.

3. A client with hypertension is prescribed a calcium channel blocker. Which client statement indicates that further teaching is needed?

• A. ‘I will take my medication at the same time every day.’
• B. ‘I should avoid drinking grapefruit juice while on this medication.’
• C. ‘I should increase my intake of calcium-rich foods.’
• D. ‘I should reduce my fluid intake to control my blood pressure.’

Correct answer: D

Rationale: The correct answer is D. The statement ‘I should reduce my fluid intake to control my blood pressure’ indicates a misunderstanding. It is important to note that fluid restriction is not typically necessary when taking calcium channel blockers. Choices A, B, and C demonstrate good understanding of medication adherence, dietary precautions, and nutrition recommendations when taking a calcium channel blocker, making them incorrect choices for further teaching.

4. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which intervention should the nurse implement first?

• A. Administer intravenous calcium gluconate.
• B. Administer intravenous insulin and glucose.
• C. Administer intravenous sodium bicarbonate.
• D. Administer a loop diuretic as prescribed.

Correct answer: B

Rationale: The correct answer is to administer intravenous insulin and glucose first. This intervention helps drive potassium back into the cells, lowering serum levels effectively. Administering intravenous calcium gluconate (choice A) is used to stabilize cardiac membranes in severe hyperkalemia but does not address the underlying cause. Administering intravenous sodium bicarbonate (choice C) is used in metabolic acidosis, not hyperkalemia. Administering a loop diuretic (choice D) can help eliminate potassium but is not the first-line treatment for hyperkalemia in CKD.

5. What is the most important instruction for the nurse to provide a client being discharged following treatment for Guillain-Barre syndrome?

• A. Avoid exposure to respiratory infections.
• B. Use relaxation exercises when anxious.
• C. Continue physical therapy at home.
• D. Plan short, frequent rest periods.

Correct answer: A

Rationale: The most critical instruction for a client being discharged following treatment for Guillain-Barre syndrome is to avoid exposure to respiratory infections. Guillain-Barre syndrome can affect the respiratory system, making infections particularly dangerous. While relaxation exercises, physical therapy, and rest periods are beneficial for overall well-being and recovery, preventing respiratory infections takes precedence due to the potential life-threatening complications associated with respiratory compromise in Guillain-Barre syndrome.

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