Nursing Elites

1. A client with acute pancreatitis is receiving total parenteral nutrition (TPN). Which laboratory value should the nurse monitor closely?

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

Correct answer: C

Rationale: In a client with acute pancreatitis receiving total parenteral nutrition (TPN), the nurse should monitor serum triglycerides closely. Acute pancreatitis can lead to fat malabsorption, making the client susceptible to hypertriglyceridemia. Monitoring serum triglycerides is crucial to prevent complications such as hyperlipidemia. While monitoring serum potassium, glucose, and calcium levels is also essential in various conditions, in this scenario, the primary concern is the risk of developing hypertriglyceridemia due to fat malabsorption.

2. When obtaining a rectal temperature with an electronic thermometer, which action is most important for the nurse to perform?

• A. Hold the thermometer in place.
• B. Place the disposable pad under the buttocks.
• C. Instruct the client to breathe deeply.
• D. Return the probe to the charger.

Correct answer: A

Rationale: When obtaining a rectal temperature with an electronic thermometer, holding the thermometer in place is crucial. This action ensures accurate temperature measurement and prevents injury to the client. Option B, placing a disposable pad under the buttocks, is not the most important action; it may enhance comfort but does not impact the accuracy of the temperature reading. Option C, instructing the client to breathe deeply, is irrelevant to obtaining a rectal temperature. Option D, returning the probe to the charger, is an incorrect action after temperature measurement.

3. The nurse is preparing to administer an IV dose of ciprofloxacin to a client with a urinary tract infection. Which client data requires the most immediate intervention by the nurse?

• A. Serum creatinine of 4.5 mg/dL (398 μmol/L SI)
• B. Temperature of 101.3°F
• C. Blood pressure of 140/90 mmHg
• D. Heart rate of 88 bpm

Correct answer: A

Rationale: A serum creatinine level of 4.5 mg/dL indicates severe renal impairment, which requires immediate attention before administering ciprofloxacin. Elevated serum creatinine levels suggest decreased kidney function, and giving ciprofloxacin can further harm the kidneys. Monitoring and addressing renal function are crucial to prevent worsening of renal impairment and potential drug toxicity. The temperature, blood pressure, and heart rate are important parameters to assess, but in this scenario, the priority is to address the severe renal impairment before proceeding with ciprofloxacin administration.

4. Which breakfast selection indicates that the client understands the nurse's instructions about the dietary management of osteoporosis?

• A. Egg whites, toast, and coffee.
• B. Bran muffin, mixed fruits, and orange juice.
• C. Granola and grapefruit juice.
• D. Bagel with jelly and skim milk.

Correct answer: D

Rationale: The correct answer is D, 'Bagel with jelly and skim milk.' This choice includes skim milk, a good source of calcium, which is important for osteoporosis management. It also avoids foods that inhibit calcium absorption. Osteoporosis dietary management emphasizes increased calcium intake and reducing foods that hinder calcium absorption. Choice A only provides proteins but lacks calcium. Choice B offers fruits and a bran muffin, but it lacks a good source of calcium. Choice C has granola but misses a significant source of calcium.

5. In a client with liver cirrhosis admitted with ascites and jaundice, which laboratory value is most concerning to the nurse?

• A. Serum albumin of 3.0 g/dl
• B. Bilirubin of 3.0 mg/dl
• C. Ammonia level of 80 mcg/dl
• D. Prothrombin time of 18 seconds

Correct answer: C

Rationale: An elevated ammonia level of 80 mcg/dl is most concerning in a client with liver cirrhosis because it may indicate hepatic encephalopathy, a serious complication. Serum albumin, though low, is expected in cirrhosis and contributes to ascites. Bilirubin elevation is common in liver disease but may not be the most concerning in this case. Prothrombin time is typically prolonged in liver disease but may not be as acute as an elevated ammonia level suggesting hepatic encephalopathy.

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