Nursing Elites

1. A client with diabetes has a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that should be prepared in the insulin syringe?

• A. 42 units
• B. 14 units
• C. 28 units
• D. 32 units

Correct answer: A

Rationale: To calculate the total number of units of insulin, you need to add the 14 units of regular insulin to the 28 units of NPH insulin, which equals 42 units. Therefore, the nurse should prepare 42 units of insulin in the syringe for the client.

2. A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

3. A healthcare professional is educating a group of recent nursing graduates about their risks for contracting hepatitis B. What preventative measure should the professional promote?

• A. Immunization
• B. Chronic tonsillitis
• C. Consumption of a vitamin-rich diet
• D. Annual vitamin K injections

Correct answer: A

Rationale: The correct preventative measure to promote for preventing hepatitis B infection is immunization. Healthcare workers, including nurses, are at risk of exposure to hepatitis B, and vaccination is crucial in preventing infection. Immunization, along with adherence to standard precautions such as using personal protective equipment, proper hand hygiene, and safe needle practices, plays a vital role in protecting healthcare workers from contracting hepatitis B.

4. The healthcare professional is caring for a client with a chest tube following a thoracotomy. Which assessment finding requires immediate intervention?

• A. Continuous bubbling in the water seal chamber.
• B. Serosanguineous drainage in the collection chamber.
• C. Intermittent bubbling in the suction control chamber.
• D. Chest tube secured to the client's chest wall.

Correct answer: A

Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which requires immediate intervention to prevent complications such as pneumothorax. An air leak can lead to ineffective lung expansion, respiratory distress, and compromised gas exchange. Therefore, prompt action is necessary to maintain the integrity of the closed drainage system and prevent further complications. Choices B, C, and D are incorrect because serosanguineous drainage is an expected finding post-thoracotomy, intermittent bubbling in the suction control chamber is normal, and having the chest tube secured to the client's chest wall is essential for stability and proper functioning.

5. An otherwise healthy 45-year-old man presents with severe hematochezia and moderate abdominal cramping since this morning. A barium enema one year ago was normal. On examination, his blood pressure is 120/78 and pulse is 100 while lying; when standing, the blood pressure is 110/76 and pulse is 136. His hematocrit is 34. What is the most likely cause of bleeding?

• A. Diverticular bleed
• B. Duodenal ulcer
• C. Inflammatory bowel disease
• D. Vascular ectasia (watermelon stomach)

Correct answer: B

Rationale: The patient's presentation with hematochezia, moderate abdominal cramping, and hemodynamic changes (increased pulse on standing) suggests an upper gastrointestinal bleed. The drop in blood pressure and rise in pulse rate when standing indicate orthostatic hypotension, which is a sign of significant blood loss. The absence of melena does not rule out an upper GI bleed. Ulcers in the duodenal bulb can erode into the gastroduodenal artery, leading to brisk blood loss. A normal barium enema one year ago makes diverticular bleeding less likely. Inflammatory bowel disease usually does not cause severe acute GI bleeding unless there is ulceration into a vessel. Vascular ectasia, like watermelon stomach, typically presents with chronic blood loss and iron deficiency anemia, more common in older women. The absence of vomiting and the presence of hematochezia make Mallory-Weiss tear less likely in this case.

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