Nursing Elites

1. A healthcare professional is reviewing a client's laboratory report and notes that the serum calcium level is 4.0 mg/dL. The healthcare professional understands that which condition most likely caused this serum calcium level?

• A. Prolonged bed rest
• B. Renal insufficiency
• C. Hyperparathyroidism
• D. Excessive ingestion of vitamin D

Correct answer: A

Rationale: Prolonged bed rest can lead to hypocalcemia due to decreased mobility and bone resorption. In this scenario, the low serum calcium level of 4.0 mg/dL is likely a result of decreased bone activity and calcium release due to prolonged bed rest. Renal insufficiency would more likely lead to hypercalcemia due to impaired excretion of calcium by the kidneys. Hyperparathyroidism is characterized by increased calcium levels as a result of excess parathyroid hormone. Excessive ingestion of vitamin D can cause hypercalcemia by increasing intestinal absorption of calcium.

2. The doctor has ordered 20 cc per hour of normal saline intravenously for your pediatric patient. You will be using pediatric intravenous tubing that delivers 60 cc per drop. How many drops per minute will you administer using this pediatric intravenous set?

• A. 30 drops per minute
• B. 25 drops per minute
• C. 20 drops per minute
• D. 22 drops per minute

Correct answer: C

Rationale: To calculate the drops per minute, first convert the ordered amount to drops per minute. 20 cc per hour equals 20 drops per hour with 60 cc per drop tubing, which is equivalent to 20 drops per hour * 60 cc per drop = 1200 drops per hour. To find drops per minute, divide 1200 by 60 (minutes in an hour), which equals 20 drops per minute. Therefore, the correct answer is 20 drops per minute. Choices A, B, and D are incorrect as they do not reflect the correct calculation based on the provided information.

3. A nurse is supervising an assistive personnel (AP) who is feeding a client who has dysphagia. Which of the following actions by the AP should the nurse identify as correct technique?

• A. Elevating the head of the client's bed to 30 degrees during mealtime
• B. Withholding fluids until the end of the meal
• C. Providing a 10-minute rest period prior to meals
• D. Instructing the client to place her chin toward her chest when swallowing

Correct answer: D

Rationale: The correct technique for a client with dysphagia is to instruct them to place their chin toward their chest when swallowing. This action helps to close off the airway during swallowing, reducing the risk of aspiration. Elevating the head of the client's bed to 30 degrees during mealtime helps prevent aspiration, but this is not the responsibility of the AP. Withholding fluids until the end of the meal can lead to dehydration and is not a recommended practice. Providing a 10-minute rest period prior to meals is not specifically related to improving swallowing safety for clients with dysphagia.

4. What is the most common cause of HHNS?

• A. Insulin overdose
• B. Removal of the adrenal gland
• C. Undiagnosed, untreated hyperpituitarism
• D. Undiagnosed, untreated diabetes mellitus

Correct answer: D

Rationale: The correct answer is D: Undiagnosed, untreated diabetes mellitus. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is most commonly caused by undiagnosed and untreated diabetes mellitus. Insulin overdose (Choice A) is not a typical cause of HHNS; it is more related to hypoglycemia. Removal of the adrenal gland (Choice B) can lead to adrenal insufficiency but is not a common cause of HHNS. Undiagnosed, untreated hyperpituitarism (Choice C) is not a usual cause of HHNS; it is more related to pituitary hormone imbalances rather than hyperglycemia.

5. Which of the following joints normally allows 360-degree circumflexion?

• A. The knee
• B. The shoulder
• C. The elbow
• D. The fingertips

Correct answer: B

Rationale: The correct answer is B: The shoulder. The shoulder joint is a ball-and-socket joint that allows for a wide range of motion, including 360-degree circumflexion. This joint provides flexibility and mobility in various directions. Choice A, the knee joint, primarily allows flexion and extension but does not have a 360-degree circumflexion. Choice C, the elbow joint, is a hinge joint that permits flexion and extension but not circumflexion. Choice D, the fingertips, do not form a specific joint that allows circumflexion; rather, they have joints that enable bending and straightening movements.

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