Nursing Elites

1. A nurse is caring for a client who has a serum calcium level of 14 mg/dL. Which provider order should the nurse implement first?

• A. Encourage oral fluid intake.
• B. Connect the client to a cardiac monitor.
• C. Assess urinary output.
• D. Administer oral calcitonin (Calcimar).

Correct answer: A

Rationale: The correct answer is to encourage oral fluid intake. With a serum calcium level of 14 mg/dL, the client is at risk of hypercalcemia. Encouraging oral fluid intake helps to promote hydration and can help prevent further elevation of calcium levels. Connecting the client to a cardiac monitor (Choice B) is important but not the first priority in this situation. Assessing urinary output (Choice C) is relevant but does not address the immediate concern of high serum calcium levels. Administering oral calcitonin (Calcimar) (Choice D) may be a treatment option later, but the first step should be to address hydration.

2. A 65-year-old male patient was admitted to a medical-surgical unit 72 hours ago with pyloric stenosis; a nasogastric tube was inserted upon admission and has been on low intermittent suction since then. The nurse taking care of the patient notices that his potassium is very low and becomes concerned that the patient may be at risk for:

• A. Hypercalcemia
• B. Metabolic acidosis
• C. Metabolic alkalosis
• D. Respiratory acidosis

Correct answer: C

Rationale: The correct answer is C, metabolic alkalosis. The patient with pyloric stenosis has been on low intermittent suction, leading to the loss of hydrogen and chloride ions. This condition causes metabolic alkalosis due to the removal of these ions. Options A (Hypercalcemia) and D (Respiratory acidosis) are incorrect as they are not directly related to the scenario described. Option B (Metabolic acidosis) is also incorrect; in this case, the patient is at risk of metabolic alkalosis due to the loss of hydrogen and chloride ions through gastric suction.

3. A nurse is caring for a client who has just had a central venous access line inserted. Which action should the nurse take next?

• A. Begin the prescribed infusion via the new access
• B. Ensure an x-ray is completed to confirm placement.
• C. Check medication calculations with a second RN.
• D. Make sure the solution is appropriate for a central line

Correct answer: B

Rationale:

4. You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly?

• A. Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
• B. Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
• C. Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
• D. Patients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate

Correct answer: B

Rationale:

5. What is the most important regulator of the amount of sodium in the body?

• A. Kidneys
• B. Small intestine
• C. Large intestine
• D. Skin

Correct answer: A

Rationale: The correct answer is A: Kidneys. The kidneys play a crucial role in regulating the amount of sodium in the body. They achieve this by filtering blood and controlling the excretion or reabsorption of sodium. The small intestine is primarily responsible for nutrient absorption, not sodium regulation. The large intestine is mainly involved in water absorption and waste elimination, not sodium balance. The skin helps regulate body temperature through sweating and does not directly regulate sodium levels.

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