Nursing Elites

1. A nurse is caring for a client with an elevated urine osmolarity. The nurse should assess the client for:

• A. fluid volume excess.
• B. hyperkalemia.
• C. hypercalcemia.
• D. fluid volume deficit.

Correct answer: D

Rationale: Elevated urine osmolarity indicates that the urine is concentrated, suggesting the body is trying to conserve water. This commonly occurs in conditions like dehydration or fluid volume deficit. Assessing the client for fluid volume excess, hyperkalemia, or hypercalcemia would not be the priority in this situation. Therefore, the correct answer is to assess the client for fluid volume deficit. Fluid volume excess is characterized by decreased urine osmolarity, while hyperkalemia and hypercalcemia are related to electrolyte imbalances and would not directly cause elevated urine osmolarity.

2. What is one characteristic of human immunodeficiency virus (HIV)?

• A. The presence of circulating antibodies that neutralize HIV is evidence of exposure to HIV.
• B. HIV replication occurs intracellularly.
• C. HIV integrates its genetic material into the host cell's DNA.
• D. DNA replication is irrelevant to HIV.

Correct answer: C

Rationale: The correct answer is C. HIV integrates its genetic material into the host cell's DNA. The virus uses the enzyme reverse transcriptase to make a DNA copy of its RNA, which is then inserted into the genetic material of the infected cell. Choice A is incorrect because the presence of antibodies does not indicate immunity to HIV but rather exposure to the virus. Choice B is incorrect as HIV replication occurs intracellularly, inside the host cell. Choice D is irrelevant to the characteristics of HIV.

3. The physician wants to know if a client is tolerating their total parenteral nutrition. Which of the following laboratory tests is likely to be ordered?

• A. triglyceride level
• B. liver function tests
• C. a glucose tolerance test
• D. a complete blood count

Correct answer: B

Rationale: The liver is crucial in processing nutrients and medications received through total parenteral nutrition. Liver function tests assess various enzymes produced by the liver, including prothrombin time/partial prothrombin time, serum glutamic oxaloacetic and pyruvic transaminases, gamma glutamyl transpeptidase, albumin, and alkaline phosphatase. Monitoring these enzymes can help determine if the liver is functioning properly to metabolize the nutrients from TPN. Triglyceride levels (Choice A) primarily evaluate the body's ability to clear fats, not specifically related to TPN tolerance. A glucose tolerance test (Choice C) is used to diagnose diabetes by measuring blood glucose levels after ingesting a glucose-rich solution, not directly related to TPN tolerance. A complete blood count (Choice D) assesses blood components such as red blood cells, white blood cells, and platelets but does not provide specific information about TPN tolerance.

4. What is the primary sign of displacement following a total hip replacement?

• A. pain on movement and weight bearing
• B. hemorrhage
• C. affected leg appearing 1-2 inches longer
• D. edema in the area of the incision

Correct answer: A

Rationale: The correct answer is pain on movement and weight bearing. This pain is the primary sign of prosthesis displacement after a total hip replacement, indicating pressure on nerves or muscles due to dislocation. Hemorrhage is not typically associated with prosthesis displacement. While the affected leg may appear longer, this is not the primary sign of displacement; it might actually be shorter due to muscle spasm. Edema in the incision area is not a primary indicator of prosthesis displacement.

5. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a maintenance dose.
• B. a loading dose.
• C. a medication with no first-pass effect.
• D. the medication to be given intravenously.

Correct answer: B

Rationale: To rapidly achieve a therapeutic plasma drug concentration, a loading or priming dose is ordered. This dose quickly establishes the desired drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose, like choice A, is used to maintain the therapeutic level after the loading dose. Waiting for steady state without a loading dose would take five drug half-lives. Choice C, a medication with no first-pass effect, does not directly address the need for rapid attainment of therapeutic levels. While intravenous administration (choice D) offers excellent bioavailability, a single dose by this route may not achieve the desired therapeutic plasma concentration as rapidly as a loading dose.

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