Nursing Elites

1. A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

• A. Osmolarity
• B. Glucose
• C. Albumin
• D. Platelets

Correct answer: B

Rationale: The correct answer is B: Glucose. Hydrocortisone can lead to increased blood glucose levels, so monitoring glucose is crucial to assess for hyperglycemia, a common side effect of corticosteroid therapy. Monitoring osmolarity (choice A) is not typically indicated in this scenario. Albumin (choice C) and platelets (choice D) are not directly affected by hydrocortisone therapy and are not the primary focus of monitoring in this case.

2. Parents of a 6-month-old child, who has just been diagnosed with iron deficiency anemia, ask why it was not diagnosed earlier. What would be the best response by the nurse?

• A. Are you sure your child has iron deficiency anemia?
• B. This happens when the maternal stores of iron are depleted at about 6 months.
• C. This anemia is caused by blood loss.
• D. The child may not have had it for a long time.

Correct answer: B

Rationale: The best response by the nurse would be choice B: 'This happens when the maternal stores of iron are depleted at about 6 months.' Iron deficiency anemia becomes apparent at about 6 months of age in a full-term infant when the maternal stores of iron are depleted. Choice A is incorrect because it questions the diagnosis provided by the healthcare provider. Choice C is incorrect because iron deficiency anemia in infants is primarily due to insufficient iron intake rather than blood loss. Choice D is incorrect as iron deficiency anemia typically develops gradually due to inadequate iron intake.

3. The nurse is teaching a client with glomerulonephritis about self-care. Which dietary recommendations should the nurse encourage the client to follow?

• A. Increase intake of high-fiber foods, such as bran cereal
• B. Restrict protein intake by limiting meats and other high-protein foods.
• C. Limit oral fluid intake to 500ml per day
• D. Increase intake of potassium-rich foods such as bananas and cantaloupe.

Correct answer: B

Rationale: The correct answer is B: Restrict protein intake by limiting meats and other high-protein foods. In glomerulonephritis, reducing protein intake helps to lower the workload on the kidneys, as excessive protein can lead to increased production of waste products that the kidneys must filter. This restriction can help prevent further damage to the kidneys. Choices A, C, and D are incorrect because: A) Increasing high-fiber foods like bran cereal is beneficial for other conditions but not specific to glomerulonephritis. C) Limiting oral fluid intake to 500ml per day is not appropriate as fluid restrictions are usually individualized based on the client's condition and kidney function. D) Increasing potassium-rich foods like bananas and cantaloupe may not be suitable for all clients with glomerulonephritis, as potassium levels can be affected in kidney disease and individual needs may vary.

4. The nurse is caring for a newborn with a myelomeningocele. Before surgery, what should the nursing interventions include?

• A. Leaving the lesion uncovered and placing the infant supine
• B. Covering the lesion with a sterile, saline-soaked gauze
• C. Applying lotion to the lesion to keep it moist
• D. Covering the lesion with a dry, sterile gauze

Correct answer: B

Rationale: The correct intervention before surgery for a newborn with a myelomeningocele is to cover the lesion with a sterile, saline-soaked gauze. This helps protect the exposed spinal cord and meninges from infection and damage. Choice A is incorrect because leaving the lesion uncovered can increase the risk of infection. Choice C is incorrect because applying lotion can introduce contaminants to the lesion. Choice D is incorrect because covering the lesion with a dry gauze can lead to adherence of the gauze to the wound, causing trauma upon removal and disrupting the healing process.

5. How are type IV hypersensitivity reactions different from all other types (I, II, or III) of hypersensitivity reactions?

• A. They involve antigen-antibody complexes.
• B. They are mediated by T cells and do not involve antibodies.
• C. They result in immediate allergic reactions.
• D. They are the least severe form of hypersensitivity.

Correct answer: B

Rationale: Type IV hypersensitivity reactions are mediated by T cells and cytokine release, leading to delayed reactions, unlike types I, II, and III, which involve antibodies. Choice A is incorrect because type IV reactions do not involve antigen-antibody complexes. Choice C is incorrect as type IV reactions do not result in immediate allergic reactions. Choice D is incorrect as type IV reactions are not the least severe form of hypersensitivity; in fact, they are known to cause significant tissue damage and inflammation.

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