Nursing Elites

1. A nurse is reviewing the laboratory results for a client who has end-stage liver disease. Which of the following findings should the nurse expect?

• A. Elevated albumin
• B. Elevated ammonia
• C. Decreased total bilirubin
• D. Decreased prothrombin time

Correct answer: B

Rationale: In end-stage liver disease, the liver's inability to convert ammonia into urea leads to elevated ammonia levels. Elevated ammonia levels can result in hepatic encephalopathy, a serious complication. Therefore, the correct answer is B. Elevated albumin (Choice A) is not typically seen in end-stage liver disease as liver dysfunction often leads to decreased albumin levels. Decreased total bilirubin (Choice C) is unlikely in end-stage liver disease, as bilirubin levels tend to be elevated due to impaired liver function. Decreased prothrombin time (Choice D) is also not expected in end-stage liver disease, as impaired liver function results in prolonged prothrombin time.

2. A nurse is caring for a client prescribed gabapentin. Which of the following should the nurse monitor?

• A. Liver function tests
• B. Renal function
• C. Blood glucose levels
• D. Cardiac rhythm

Correct answer: B

Rationale: The correct answer is B: Renal function. Gabapentin is primarily eliminated by the kidneys, so monitoring renal function is essential to ensure the drug is being cleared effectively from the body. Monitoring liver function tests (choice A) is not a priority for gabapentin as it is not primarily metabolized by the liver. Blood glucose levels (choice C) are not directly impacted by gabapentin. Cardiac rhythm (choice D) monitoring is not typically necessary for clients on gabapentin unless they have pre-existing cardiac conditions that may be exacerbated by the medication.

3. A client with mild persistent asthma is being taught about montelukast by a nurse. Which statement by the client indicates understanding?

• A. I will use this for asthma attacks.
• B. I should take this before exercise.
• C. This medication will decrease swelling and mucus production.
• D. I can stop this medication after 10 days.

Correct answer: C

Rationale: The correct answer is C: 'This medication will decrease swelling and mucus production.' Montelukast is a leukotriene receptor antagonist that works by reducing swelling and mucus production in the airways, helping to manage asthma symptoms in the long term. Choices A, B, and D are incorrect because montelukast is not used for immediate relief during asthma attacks, pre-exercise prophylaxis, or short-term treatment; instead, it is taken regularly for asthma control.

4. A client has been prescribed ferrous sulfate. Which instruction should the nurse include?

• A. Take with meals
• B. Take with a glass of orange juice
• C. Take at bedtime
• D. Take with milk

Correct answer: B

Rationale: The correct instruction for a client prescribed ferrous sulfate is to take it with a glass of orange juice. Vitamin C, found in orange juice, enhances the absorption of iron, making it more effective. Taking ferrous sulfate with meals, at bedtime, or with milk can decrease its absorption and effectiveness, so these options are incorrect.

5. A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following statements by the client indicates a need for further teaching?

• A. I will notify my doctor if I develop a cough.
• B. I will avoid using salt substitutes.
• C. I will increase my intake of potassium-rich foods.
• D. I will monitor my blood pressure regularly.

Correct answer: C

Rationale: The correct answer is C. Clients taking lisinopril should avoid potassium-rich foods because ACE inhibitors can increase potassium levels, potentially leading to hyperkalemia. Choices A, B, and D are all correct statements. Clients should notify their doctor if they develop a cough as it can indicate a potential side effect of lisinopril. Avoiding salt substitutes is important as they may contain potassium chloride, which can also raise potassium levels. Monitoring blood pressure regularly is essential when taking an antihypertensive medication like lisinopril.

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