Nursing Elites

1. A middle-aged adult with a family history of CAD has the following: total cholesterol 198 (11 mmol/L); LDL cholesterol 120 (6.7 mmol/L); HDL cholesterol 58 (3.2 mmol/L); triglycerides 148 (8.2 mmol/L); blood sugar 102 (5.7 mmol/L); and C-reactive protein (CRP) 4.2. The health care provider prescribes a statin medication and aspirin. The client asks the nurse why these medications are needed. Which is the best response by the nurse?

• A. The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a low-fat diet.
• B. The triglycerides are elevated and will not return to normal without these medications.
• C. The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications prescribed.
• D. These medications will reduce the risk of type 2 diabetes.

Correct answer: C

Rationale: CRP is a marker of inflammation, which is elevated in cardiovascular disease. Statins and aspirin help lower CRP and reduce the risk of heart attacks and strokes.

2. A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:

• A. Increase the frequency of self-monitoring (blood glucose testing).
• B. Reduce food intake to alleviate nausea.
• C. Discontinue the insulin dose if unable to eat.
• D. Take the normal dose of insulin.

Correct answer: A

Rationale: During illness, individuals with type 1 diabetes mellitus may experience increased insulin requirements due to factors such as stress and the release of counterregulatory hormones. Increasing the frequency of self-monitoring, as stated in choice A, is crucial to closely monitor and adjust insulin doses as needed. Choice B, reducing food intake to alleviate nausea, is incorrect as it may lead to hypoglycemia and does not address the increased insulin needs during illness. Choice C, discontinuing the insulin dose if unable to eat, is dangerous as it can result in uncontrolled hyperglycemia. Choice D, taking the normal dose of insulin, may not be sufficient during illness when insulin requirements are likely elevated.

3. In a patient with deep vein thrombosis (DVT), which of the following symptoms would be expected?

• A. Chest pain.
• B. Shortness of breath.
• C. Coughing up blood.
• D. Cyanosis.

Correct answer: B

Rationale: Shortness of breath is a common symptom of deep vein thrombosis (DVT) due to the risk of a pulmonary embolism. DVT occurs when a blood clot forms in a deep vein, usually in the legs. If a portion of the clot breaks loose and travels to the lungs, it can cause a pulmonary embolism, leading to symptoms like shortness of breath. Chest pain is more commonly associated with conditions like a heart attack or pulmonary embolism itself. Coughing up blood is a symptom more indicative of conditions such as pulmonary embolism or lung cancer. Cyanosis, which is a bluish discoloration of the skin or mucous membranes due to poor oxygenation, can be seen in severe cases of pulmonary embolism but is not a typical symptom of DVT.

4. When performing a health history on a patient who is to begin receiving a thiazide diuretic to treat heart failure, the nurse will be concerned about a history of which condition?

• A. Asthma
• B. Glaucoma
• C. Gout
• D. Hypertension

Correct answer: C

Rationale: Thiazide diuretics block uric acid secretion, leading to elevated levels that can contribute to gout. Therefore, patients with a history of gout should take thiazide diuretics with caution. Asthma (Choice A), Glaucoma (Choice B), and Hypertension (Choice D) are not directly contraindicated with thiazide diuretics, making choices A, B, and D incorrect.

5. The patient will begin taking doxycycline to treat an infection. When should the nurse plan to give this medication?

• A. 1 hour before or 2 hours after a meal.
• B. with an antacid to minimize GI irritation.
• C. with food to improve absorption.
• D. with small sips of water.

Correct answer: C

Rationale: Doxycycline is a lipid-soluble tetracycline that is better absorbed when taken with milk products and food. Taking doxycycline with food helps improve its absorption. It should not be taken on an empty stomach, as this can decrease its effectiveness. Antacids can interfere with the absorption of tetracyclines, so they should not be taken together. While it is important to stay hydrated when taking medications, small sips of water are not specifically recommended for doxycycline administration.

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