An older adult client is brought to an urgent care clinic by her paid in-home caregiver for a suspected UTI. The client has bruising to the left side of her face and appears fearful when her caregiver makes sudden movements. Which priority action should the nurse take first?

Notify adult protective services about possible elder abuse by the caregiver.

Have the caregiver stay in the waiting area while the client is brought into a room for assessment.

Contact the caregiver's employment agency to report the suspicion of abuse.

Ask the patient how the injury occurred and observe the caregiver's reaction.

Answer and Explanation

The Correct Answer is B

A.   This action is crucial if there is a suspicion of elder abuse, as adult protective services (APS) can investigate the situation thoroughly and take necessary measures to protect the client. However, before making such a notification, it is important to assess the immediate safety of the client and gather preliminary information.
B.   This is a prudent initial action to ensure that the client is in a safe environment away from the caregiver, who may be the suspected abuser. It allows the nurse to conduct a private and thorough assessment of the client without the potential influence or intimidation from the caregiver. This step is critical for ensuring the client's safety and obtaining unbiased information.
C.   While reporting to the caregiver’s employment agency may be a step in the process, it is not the immediate priority. The primary focus should be on ensuring the client’s safety and assessing the situation before contacting external agencies.
D.   While it is important to gather information about how the injury occurred, the immediate priority is to ensure the client's safety and provide an opportunity for a private assessment. The presence of the caregiver during this conversation could influence the client's responses or cause additional stress.

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Correct Answer is A

Explanation

A. Increased energy levels are a common and positive sign of therapeutic response to levothyroxine. Hypothyroidism often leads to fatigue and low energy. When levothyroxine is effective, it helps normalize thyroid hormone levels, which can lead to improved energy levels and a reduction in symptoms like fatigue and lethargy.
B. An increase in weight is not a desired outcome of levothyroxine therapy. In hypothyroidism, weight gain is a common symptom due to slowed metabolism. Successful levothyroxine treatment should help stabilize or reduce weight if it was previously increased due to hypothyroidism. An increase in weight could indicate that the dose of levothyroxine needs adjustment or that other factors are influencing the patient's weight.
C. A decrease in the level of thyroxine (T4) would not typically indicate a therapeutic response to levothyroxine. In fact, the goal of treatment is to normalize T4 levels, so they should be within the normal reference range. An adequate dose of levothyroxine should result in normal or near-normal T4 levels, not a decrease below the normal range.
D. A reduction in appetite is not a common or specific indicator of a therapeutic response to levothyroxine. While levothyroxine can help normalize metabolism and other symptoms of hypothyroidism, a reduction in appetite is not a typical outcome of effective therapy. Appetite changes are not usually used to gauge the effectiveness of thyroid hormone replacement.

A. Atrial fibrillation B. Atrial flutter C. Unstable angina D. Premature atrial contractions

Correct Answer is B

Explanation

A. Atrial fibrillation is characterized by irregularly irregular rhythms with no distinct P-waves. Instead, it has a chaotic baseline with fibrillatory waves. The ventricular response can be irregular and variable. The description provided (regular P-waves in a sawtooth formation) does not match the typical appearance of atrial fibrillation, which lacks regular P-waves and has an irregular rhythm.
B. Atrial flutter is characterized by regular, sawtooth-shaped P-waves known as "F-waves" or "flutter waves." The classic pattern is referred to as "F-waves" with a "sawtooth" appearance, often seen in the inferior leads (II, III, aVF). The atrial rate is typically between 240 to 340 beats per minute, which fits the rate of 260 beats per minute in the description. The ventricular rate can be regular or irregular, depending on the degree of AV node conduction. A

C. Unstable angina is a clinical diagnosis of chest pain due to myocardial ischemia. It is not associated with specific ECG findings related to the P-wave morphology or rate. The ECG findings described do not correspond to unstable angina, which would typically present with ST-segment changes or other signs of myocardial ischemia rather than a specific P-wave pattern.
D. Premature atrial contractions (PACs) are early beats originating from the atria that interrupt the normal rhythm. They usually present as a single early beat with a different morphology of the P-wave compared to the sinus P-waves, but do not result in a regular sawtooth pattern or a sustained rhythm at high rates like the one described.

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An older adult client is brought to an urgent care clinic by her paid in-home caregiver for a suspected UTI. The client has bruising to the left side of her face and appears fearful when her caregiver makes sudden movements. Which priority action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

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A nurse is reviewing the laboratory results of a client who has a new diagnosis of Hashimoto's disease. Which of the following lab results would the nurse expect to find?

A client is admitted to the hospital with a diagnosis of obstruction of the common bile duct due to cholelithiasis. Which of the following assessment findings are consistent with this diagnosis?

A nurse is caring for an 83-year-old client who asks for a warm blanket despite the room temperature being 80°F. The nurse understands that which of the following physiological changes experienced by older adults makes it more difficult for them maintain their body temperature?

A nurse in an eye clinic is obtaining a health history from a client who is being evaluated for suspected cataracts. The nurse understands that which of the following medications is associated with an increased risk of developing cataracts?