Nursing Elites

1. A nurse is reviewing the medical record of a client who has a new prescription for spironolactone. Which of the following findings should the nurse report to the provider?

• A. Potassium 4.0 mEq/L
• B. Calcium 9.5 mg/dL
• C. Magnesium 2.0 mEq/L
• D. Serum creatinine 3.0 mg/dL

Correct answer: D

Rationale: A serum creatinine level of 3.0 mg/dL indicates impaired kidney function, which is a concern when prescribing spironolactone as it can further affect renal function. Elevated serum creatinine levels may suggest decreased renal clearance of spironolactone, leading to potential toxicity. Potassium, calcium, and magnesium levels are within normal ranges and not directly related to spironolactone therapy. Therefore, the nurse should report the elevated serum creatinine level to the provider for further evaluation and possible dosage adjustment.

2. A nurse is assessing a client who has heart failure and is receiving furosemide. Which of the following findings should the nurse identify as an indication that the client is developing hypokalemia?

• A. Positive Trousseau's sign.
• B. Hyperactive reflexes.
• C. Hypoactive bowel sounds.
• D. Decreased deep-tendon reflexes.

Correct answer: A

Rationale: The correct answer is A: Positive Trousseau's sign. When a patient receiving furosemide is developing hypokalemia, they may exhibit a positive Trousseau's sign, an indication of low potassium levels. This sign is elicited by inflating a blood pressure cuff above systolic pressure for a few minutes, resulting in carpal spasm. Choices B, C, and D are incorrect. Hyperactive reflexes are associated with hyperkalemia, not hypokalemia. Hypoactive bowel sounds are not specifically related to hypokalemia. Decreased deep-tendon reflexes are not typically seen in hypokalemia.

3. A nurse is teaching a prenatal class about infection prevention. Which of the following statements indicates an understanding of the teaching?

• A. I can visit someone with chickenpox 5 days after the sores crust.
• B. I should avoid cleaning my cat's litter box during pregnancy.
• C. I should wash my hands with hot water for 10 seconds after gardening.
• D. I can take antibiotics for viral infections.

Correct answer: B

Rationale: The correct answer is B because avoiding cleaning the cat's litter box during pregnancy reduces the risk of toxoplasmosis, which can be harmful to the developing fetus. Choice A is incorrect because visiting someone with chickenpox should be avoided as it is highly contagious. Choice C is incorrect as handwashing after gardening should involve soap and water, not just hot water, for effective infection prevention. Choice D is incorrect because antibiotics are ineffective against viral infections.

4. A nurse is caring for a client who is postoperative following a craniotomy. Which of the following findings indicates the client is developing diabetes insipidus?

• A. Polyuria
• B. Hypertension
• C. Bradycardia
• D. Hyperglycemia

Correct answer: A

Rationale: Polyuria is the correct finding indicating the client is developing diabetes insipidus. Diabetes insipidus is characterized by the excretion of large volumes of diluted urine due to a deficiency in antidiuretic hormone. This results in increased urine output (polyuria) despite adequate fluid intake. Hypertension (choice B) is not typically associated with diabetes insipidus but can be seen in other conditions. Bradycardia (choice C) and hyperglycemia (choice D) are also not typical findings of diabetes insipidus.

5. A client is receiving discharge teaching regarding a new prescription for warfarin. Which of the following statements by the client indicates a need for further teaching?

• A. I will eat more leafy green vegetables while taking warfarin.
• B. I will have my INR checked regularly while taking warfarin.
• C. I will avoid drinking grapefruit juice while taking warfarin.
• D. I will use a soft toothbrush while taking warfarin.

Correct answer: A

Rationale: The correct answer is A. Clients taking warfarin should avoid leafy green vegetables as they are high in vitamin K, which can reduce the effectiveness of the medication. Therefore, the statement 'I will eat more leafy green vegetables while taking warfarin' indicates a need for further teaching. Choice B is correct as regular monitoring of INR levels is necessary for clients on warfarin. Choice C is correct as grapefruit juice can interact with warfarin and should be avoided. Choice D is correct as using a soft toothbrush is recommended to prevent gum bleeding while on warfarin.

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