Nursing Elites

1. A female patient is prescribed metformin for glucose control. The patient is on NPO status pending a diagnostic test. The nurse is most concerned about which side effect of metformin?

• A. Diarrhea and Vomiting
• B. Dizziness and Drowsiness
• C. Metallic taste
• D. Hypoglycemia

Correct answer: D

Rationale: The correct answer is 'Hypoglycemia.' When a patient is on NPO status (nothing by mouth) and prescribed metformin, there is an increased risk of hypoglycemia due to the absence of oral intake. Metformin, as an anti-glycemic drug, can lower blood sugar levels, and without food intake, the risk of hypoglycemia is higher. Diarrhea and vomiting are common gastrointestinal side effects of metformin but are not the main concern in this scenario. Dizziness and drowsiness are potential side effects of some medications but are not typically associated with metformin. Metallic taste is a known side effect of metformin but is not the primary concern in this situation where hypoglycemia is more critical to monitor due to the patient's NPO status.

2. A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

• A. The patient reports no chest pain.
• B. Blood pressure is 140/90 mm Hg
• C. Stools test negative for occult blood.
• D. The apical pulse rate is 68 beats/minute.

Correct answer: C

Rationale: The best indicator that propranolol has been effective in a patient with cirrhosis and esophageal varices is when the stools test negative for occult blood. Propranolol is prescribed to decrease the risk of bleeding from esophageal varices. This medication's effectiveness is primarily assessed by the absence of blood in the stools, indicating a reduction in the risk of bleeding from the varices. Monitoring for chest pain, blood pressure control, and a decrease in heart rate are important parameters in other conditions treated with propranolol, such as hypertension, angina, and tachycardia, but in this particular case, the absence of occult blood in the stools is the most relevant indicator of treatment success.

3. A physician suspects a patient may have pancreatitis. Which of the following tests would be most appropriate to diagnose this condition?

• A. CK and Troponin
• B. BUN and Creatinine
• C. Amylase and Lipase
• D. HDL and LDL Cholesterol Levels

Correct answer: C

Rationale: To diagnose pancreatitis, testing amylase and lipase levels is crucial. Amylase and lipase are enzymes produced by the pancreas that help digest carbohydrates and lipids. In pancreatitis, these enzymes are released in high amounts into the bloodstream due to pancreatic inflammation or damage. Elevated levels of amylase and lipase in blood tests strongly indicate pancreatitis. Choice A, CK and Troponin, are cardiac markers used in diagnosing heart conditions like myocardial infarction, not pancreatitis. Choice B, BUN and Creatinine, are kidney function tests, not specific to pancreatitis. Choice D, HDL and LDL Cholesterol Levels, are lipid profile tests used to assess cardiovascular health, not for diagnosing pancreatitis.

4. What is the most frequent cause for suicide in adolescents?

• A. Progressive failure to adapt
• B. Feelings of anger or hostility
• C. Reunion wish or fantasy
• D. Feelings of alienation or isolation

Correct answer: D

Rationale: Feelings of alienation or isolation are the most frequent cause for suicide in adolescents. Adolescents may experience a gradual isolation leading to a loss of meaningful social contacts, which can be self-imposed or result from an inability to express feelings. During this developmental stage, achieving a sense of identity and peer acceptance is crucial. Choices A, B, and C are incorrect: Progressive failure to adapt, feelings of anger or hostility, and reunion wish or fantasy are not typically identified as the primary cause of suicide in adolescents.

5. An 80-year-old patient is admitted with dyspnea, dependent edema, rales, and distended neck veins. As the nurse monitors the patient, he becomes increasingly short of breath and begins to have cardiac dysrhythmias. The most critical intervention for this patient is to:

• A. Ensure his airway is open and unobstructed.
• B. Apply oxygen to maintain his oxygen saturation above 94%.
• C. Administer Dobutamine to increase cardiac output.
• D. Start an IV for monitoring fluid intake.

Correct answer: A

Rationale: In a patient presenting with dyspnea, dependent edema, rales, distended neck veins, and developing cardiac dysrhythmias, the priority intervention is to ensure the airway is open and unobstructed. Maintaining an open airway is crucial for adequate ventilation and oxygenation, especially in a patient showing signs of impending respiratory distress and cardiac compromise. While applying oxygen to maintain oxygen saturation is important, ensuring airway patency takes precedence as it directly impacts the patient's ability to breathe. Administering Dobutamine may be necessary to improve cardiac output; however, addressing the airway first is essential to prevent further respiratory distress and worsening dysrhythmias. Starting an IV for monitoring fluid intake is not the most critical intervention in this scenario compared to ensuring airway patency and oxygenation.

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