Nursing Elites

1. A nurse is reviewing the laboratory values of a client who has liver cirrhosis. Which of the following findings should the nurse report to the provider?

• A. Bilirubin 0.8 mg/dL
• B. Ammonia 35 mcg/dL
• C. Prothrombin time 16 seconds
• D. Albumin 4 g/dL

Correct answer: C

Rationale: In clients with liver cirrhosis, an elevated prothrombin time indicates impaired liver function and decreased production of clotting factors. This finding should be reported to the provider for further evaluation and management. Choices A, B, and D are within normal ranges and do not specifically indicate worsening liver cirrhosis. Bilirubin 0.8 mg/dL is normal, ammonia 35 mcg/dL is within the reference range, and albumin 4 g/dL is also within the normal range for this client population.

2. What is the best position for a patient with respiratory distress?

• A. Semi-Fowler's position
• B. Trendelenburg position
• C. Prone position
• D. Supine position

Correct answer: A

Rationale: The best position for a patient with respiratory distress is the Semi-Fowler's position. This position promotes lung expansion and improves oxygenation by allowing the chest to expand more fully. The Trendelenburg position, where the patient's feet are higher than the head, is contraindicated in respiratory distress as it can increase pressure on the diaphragm and compromise breathing. The prone position, lying face down, may be beneficial in certain cases like acute respiratory distress syndrome but is not generally recommended for all patients in respiratory distress. The supine position, lying flat on the back, can worsen respiratory distress by causing the tongue to fall back and obstruct the airway.

3. A nurse is teaching a client who has a new prescription for alendronate. Which of the following instructions should the nurse include in the teaching?

• A. Take this medication at bedtime.
• B. Take this medication with food.
• C. Remain upright for at least 30 minutes after taking this medication.
• D. Avoid taking this medication with calcium-rich foods.

Correct answer: C

Rationale: The correct answer is C: 'Remain upright for at least 30 minutes after taking this medication.' This instruction is crucial when taking alendronate as it reduces the risk of esophagitis by preventing the medication from irritating the esophagus. Choice A is incorrect because alendronate should be taken in the morning, not at bedtime, to enhance absorption. Choice B is incorrect as alendronate should be taken on an empty stomach, preferably in the morning, with a full glass of water. Choice D is incorrect as there are no specific restrictions on taking alendronate with calcium-rich foods.

4. A nurse is assessing a client who has been taking lithium for bipolar disorder. Which of the following findings should the nurse report to the provider?

• A. Tremors
• B. Increased thirst
• C. Weight gain
• D. Diarrhea

Correct answer: A

Rationale: Corrected Rationale: Tremors can indicate lithium toxicity, which should be reported to the provider for further evaluation. Tremors are a significant sign of lithium toxicity and can lead to serious complications if not addressed promptly. Increased thirst, weight gain, and diarrhea are common side effects of lithium but are not typically indicative of toxicity. Therefore, the nurse should prioritize reporting tremors as it requires immediate attention.

5. A nurse is caring for a client who is at risk for pressure ulcers. Which of the following interventions should the nurse implement?

• A. Turn the client every 2 hours
• B. Use a donut-shaped cushion when sitting
• C. Elevate the head of the bed to 45 degrees
• D. Massage reddened areas to increase circulation

Correct answer: A

Rationale: The correct intervention for preventing pressure ulcers in a client at risk is to turn the client every 2 hours. This helps relieve pressure on bony prominences, improving circulation and preventing tissue damage. Using a donut-shaped cushion can actually increase pressure on the skin and worsen the risk of pressure ulcers. Elevating the head of the bed to 45 degrees is beneficial for preventing aspiration in some cases but does not directly address pressure ulcer prevention. Massaging reddened areas can further damage the skin and increase the risk of pressure ulcer development by causing friction and shearing forces.

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