Nursing Elites

1. A client is admitted with a possible myocardial infarction. Which laboratory test result is most indicative of a myocardial infarction?

• A. Serum creatine kinase (CK)
• B. Serum troponin
• C. Serum myoglobin
• D. C-reactive protein (CRP)

Correct answer: B

Rationale: Serum troponin is the most specific and sensitive indicator of myocardial infarction. Troponin levels rise within 3-4 hours after myocardial damage, peak at 10-24 hours, and remain elevated for up to 10-14 days. Creatine kinase (CK) and myoglobin can also be elevated in myocardial infarction, but troponin is more specific to cardiac muscle damage. C-reactive protein (CRP) is a marker of inflammation and is not specific for myocardial infarction.

2. The nurse is caring for a client who is postoperative following a thyroidectomy. Which laboratory value should be monitored closely?

• A. Serum calcium of 8.5 mg/dL
• B. Serum sodium of 136 mEq/L
• C. Serum potassium of 3.0 mEq/L
• D. Serum chloride of 102 mEq/L

Correct answer: C

Rationale: A serum potassium level of 3.0 mEq/L should be monitored closely in a client who is postoperative following a thyroidectomy to detect any electrolyte imbalances. After a thyroidectomy, there is a risk of hypokalemia due to the effects of anesthesia, stress response, and the surgical procedure itself. Monitoring serum potassium levels is crucial as hypokalemia can lead to cardiac arrhythmias and muscle weakness. Serum calcium, sodium, and chloride levels are important but not the primary focus following a thyroidectomy, making them incorrect choices.

3. The nurse is caring for a client with acute pancreatitis who is receiving total parenteral nutrition (TPN). Which laboratory value should be monitored closely?

• A. Serum calcium
• B. Serum triglycerides
• C. Serum glucose
• D. Serum triglycerides

Correct answer: B

Rationale: Serum triglycerides should be monitored closely in a client receiving TPN as they may indicate hyperlipidemia, which is a potential complication of TPN. Monitoring serum triglycerides is essential to prevent complications such as hypertriglyceridemia. Serum calcium and glucose levels are also important to monitor in clients receiving TPN, but in this scenario, serum triglycerides take priority due to the risk of hyperlipidemia.

4. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 50 ml/hour
• B. 25 ml/hour
• C. 75 ml/hour
• D. 100 ml/hour

Correct answer: C

Rationale: To calculate the infusion rate, convert 1 mg to 1,000 mcg (1 mg = 1,000 mcg) and then use the formula D/H x Q, where D is the desired dose, H is the dose on hand, and Q is the quantity of solution. In this case, it would be 300 mcg/hour / 1,000 mcg x 250 ml = 75 ml/hour. Therefore, the nurse should program the infusion pump to deliver 75 ml/hour. Choice A (50 ml/hour), Choice B (25 ml/hour), and Choice D (100 ml/hour) are incorrect as they do not correspond to the calculated rate of 75 ml/hour.

5. A 46-year-old male client who had a myocardial infarction 24 hours ago comes to the nurse's station fully dressed and wanting to go home. He tells the nurse that he is feeling much better at this time. Based on this behavior, which nursing problem should the nurse formulate?

• A. Ineffective coping related to denial.
• B. Risk for impaired cardiac function.
• C. Noncompliance related to lack of knowledge.
• D. Anxiety related to hospitalization.

Correct answer: A

Rationale: The correct answer is A: Ineffective coping related to denial. The client's desire to leave the hospital shortly after a myocardial infarction despite the severity of the condition indicates denial and ineffective coping. This behavior could lead to complications as the client may not adequately address his health needs. Choice B, Risk for impaired cardiac function, is not the most appropriate nursing problem in this scenario as the client's behavior is more indicative of psychological coping issues rather than a direct physiological risk at this moment. Choice C, Noncompliance related to lack of knowledge, does not align with the client's behavior of wanting to leave the hospital. Choice D, Anxiety related to hospitalization, may not be the best option as the client's behavior is more suggestive of denial rather than anxiety about being hospitalized.

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