Nursing Elites

1. A client receiving total parenteral nutrition (TPN) through a central line suddenly develops dyspnea, chest pain, and a drop in blood pressure. What should the nurse do first?

• A. Stop the TPN infusion.
• B. Notify the healthcare provider.
• C. Place the client in Trendelenburg position.
• D. Administer oxygen at 2 liters/minute.

Correct answer: C

Rationale: Placing the client in Trendelenburg position should be the initial action as it can help manage a suspected air embolism, a potential complication of TPN administration. This position helps trap air in the apex of the atrium, reducing the risk of air reaching the pulmonary circulation and causing further harm. Once the client is in a safe position, further actions such as stopping the TPN infusion, notifying the healthcare provider, and administering oxygen can be taken as appropriate.

2. What is/are the possible cause(s) of acute pancreatitis in this patient?

• A. HIV
• B. Cytomegalovirus
• C. Dideoxyinosine (ddI)
• D. Pentamidine

Correct answer: B

Rationale: This patient presents with symptoms and lab findings consistent with acute pancreatitis. Cytomegalovirus is a common viral infection associated with pancreatitis. In patients with AIDS, the pancreas can be affected by various infections (e.g., cryptococcus, Mycobacterium tuberculosis, candida, Toxoplasma gondii) and medications (such as ddI, pentamidine, trimethoprim/sulfamethoxazole, metronidazole) can also lead to acute pancreatitis. While HIV infection predisposes individuals to various opportunistic infections, in this case, the most likely cause of the acute pancreatitis is cytomegalovirus infection.

3. The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?

• A. Hemoglobin level of 12 g/dL.
• B. Platelet count of 150,000/mm3.
• C. White blood cell count of 2,000/mm3.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: C

Rationale: A white blood cell count of 2,000/mm3 is low and indicates leukopenia, which increases the client's risk for infection. Hemoglobin level and platelet count are not directly indicative of infection risk. Serum creatinine level is related to kidney function, not infection risk.

4. The patient has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?

• A. Maintain the patient on bed rest.
• B. Auscultate lung sounds every 4 hours.
• C. Monitor for Trousseau's and Chvostek's signs.
• D. Encourage fluid intake up to 4000 mL every day.

Correct answer: D

Rationale: The correct action for the nurse to include on the care plan for a patient with a calcium level of 12.1 mg/dL is to encourage fluid intake up to 4000 mL every day. This is essential to decrease the risk for renal calculi associated with hypercalcemia. While bed rest is not necessary, ambulation is encouraged to help decrease the loss of calcium from the bone. Monitoring for Trousseau's and Chvostek's signs is more relevant when hypocalcemia is suspected. Auscultating lung sounds every shift is a routine assessment, not required every 4 hours unless there is a specific respiratory concern.

5. A patient with rheumatoid arthritis is taking prednisone. What is an important side effect for the nurse to monitor?

• A. Hyperglycemia
• B. Bradycardia
• C. Hypotension
• D. Hyperkalemia

Correct answer: A

Rationale: The correct answer is hyperglycemia. Prednisone, a corticosteroid, can lead to elevated blood sugar levels as a side effect, particularly in patients with diabetes or those predisposed to developing diabetes. Monitoring for hyperglycemia is crucial to prevent complications like diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome.

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