Nursing Elites

1. A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is receiving 3% sodium chloride via continuous IV. Which of the following laboratory findings should the nurse identify as an indication that the SIADH is resolving?

• A. Urine specific gravity 1.020
• B. Sodium 119 mEq/L
• C. BUN 8 mg/dL
• D. Calcium 8.7 mg/dL

Correct answer: A

Rationale: A urine specific gravity of 1.020 is within the expected reference range and indicates that the kidneys are appropriately concentrating urine, which is a sign that the syndrome of inappropriate antidiuretic hormone (SIADH) is resolving. A low sodium level (choice B) is associated with SIADH, so a sodium level of 119 mEq/L is not indicative of resolution. BUN (choice C) and calcium levels (choice D) are typically not directly related to SIADH resolution.

2. What should a healthcare provider monitor for in a patient with HIV and a CD4 T-cell count below 180 cells/mm3?

• A. Monitor for signs of infection
• B. Monitor for anemia
• C. Monitor for dehydration
• D. Monitor for bleeding

Correct answer: A

Rationale: A CD4 T-cell count below 180 cells/mm3 indicates severe immunocompromise in a patient with HIV. Monitoring for signs of infection is crucial because the patient is at high risk of developing opportunistic infections. Anemia (choice B), dehydration (choice C), and bleeding (choice D) are not directly associated with a low CD4 T-cell count in patients with HIV.

3. What are the expected manifestations of a thrombotic stroke?

• A. Gradual loss of function on one side of the body
• B. Loss of sensation in the affected extremity
• C. Sudden loss of consciousness
• D. Seizures and convulsions

Correct answer: A

Rationale: The correct answer is A: Gradual loss of function on one side of the body. Thrombotic strokes are caused by a clot forming in a blood vessel supplying the brain, leading to a gradual onset of symptoms due to impaired blood flow to specific brain regions. Choices B, C, and D are incorrect because loss of sensation, sudden loss of consciousness, seizures, and convulsions are not typically associated with thrombotic strokes. In a thrombotic stroke, the symptoms develop slowly over time, often over minutes to hours, and include manifestations such as weakness, numbness, or paralysis on one side of the body, along with other symptoms related to the affected brain area.

4. A nurse in a rural community center is providing education to a group of clients about first aid interventions for snake bites. Which of the following instructions should the nurse include in the teaching?

• A. Apply an ice pack directly to the affected area
• B. Immobilize the affected extremity with a splint
• C. Place a tourniquet above and below the affected area
• D. Elevate the affected extremity

Correct answer: B

Rationale: The correct answer is to immobilize the affected extremity with a splint. This helps to slow the spread of venom by limiting movement. Applying an ice pack directly to the affected area (Choice A) is not recommended for snake bites as it could exacerbate tissue damage. Placing a tourniquet above and below the affected area (Choice C) is also not advised as it can lead to further complications. Elevating the affected extremity (Choice D) is not recommended for snake bites; keeping it below the level of the heart is more appropriate to reduce venom spread.

5. A patient is admitted with chest pain, possible acute coronary syndrome. What should the nurse do first?

• A. Administer sublingual nitroglycerin
• B. Get IV access
• C. Obtain cardiac enzymes
• D. Auscultate heart sounds

Correct answer: A

Rationale: In a patient with chest pain, possible acute coronary syndrome, the nurse should administer sublingual nitroglycerin first. Nitroglycerin helps to vasodilate coronary arteries, improving blood flow to the heart, and reducing cardiac workload. This can alleviate chest pain and decrease cardiac tissue damage in acute coronary syndrome. Getting IV access, obtaining cardiac enzymes, and auscultating heart sounds are important steps in the assessment and management of acute coronary syndrome, but administering nitroglycerin to relieve chest pain and improve blood flow takes precedence as it directly addresses the patient's symptoms and aims to prevent further cardiac damage.

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