Nursing Elites

1. A young adult client, admitted to the emergency department following a motor vehicle collision, is transfused with 4 units of PRBCs. The client’s pretransfusion hematocrit is 17%. Which hematocrit value should the nurse expect the client to have after all PRBCs have been transfused?

• A. 23%
• B. 25%
• C. 27%
• D. 29%

Correct answer: D

Rationale: One unit of PRBCs typically raises the hematocrit by 3%. Since the client received 4 units, the hematocrit is expected to increase by approximately 12% (4 units x 3% per unit). Therefore, the nurse should expect the client's hematocrit to be 29% after all PRBCs have been transfused. Choices A, B, and C are incorrect as they do not account for the cumulative effect of multiple PRBC units on the hematocrit level.

2. A client with chronic heart failure is being discharged with a new prescription for furosemide. Which instruction should the nurse include in the discharge teaching?

• A. Increase your intake of potassium-rich foods.
• B. Restrict your fluid intake to 1 liter per day.
• C. Avoid salt substitutes containing potassium.
• D. Weigh yourself once a week.

Correct answer: A

Rationale: The correct answer is to instruct the client to increase their intake of potassium-rich foods. Furosemide is a loop diuretic that can lead to potassium loss due to increased urinary excretion. Potassium-rich foods can help prevent hypokalemia, a potential side effect of furosemide. Restricting fluid intake (choice B) may not be suitable for all patients with heart failure, and a general restriction of 1 liter per day is not typically recommended. Avoiding salt substitutes containing potassium (choice C) is not a priority teaching point in this scenario. Weighing oneself once a week (choice D) is important for monitoring fluid status, but increasing potassium-rich foods is more directly related to the potential side effects of furosemide.

3. When caring for a 7-week-old infant with hypothyroidism, the nurse explains that the prevention of what complication is dependent on the administration of oral thyroid replacement therapy and is critical for the child?

• A. Excessive growth
• B. Cognitive impairment
• C. Damage to the nervous system
• D. Damage to the urinary system

Correct answer: B

Rationale: The correct answer is B: Cognitive impairment. The treatment of choice for congenital and acquired hypothyroidism is oral thyroid hormone replacement therapy. Prompt treatment is especially critical in the infant with congenital hypothyroidism to avoid permanent cognitive impairment. Excessive growth (Choice A) is not a common complication of hypothyroidism in infants. Damage to the nervous system (Choice C) and damage to the urinary system (Choice D) are not typically associated with untreated hypothyroidism in infants.

4. A client with cirrhosis is receiving lactulose. What is the desired effect of this medication?

• A. Decrease blood glucose levels
• B. Reduce serum ammonia levels
• C. Increase platelet count
• D. Lower serum bilirubin levels

Correct answer: B

Rationale: The correct answer is B: Reduce serum ammonia levels. Lactulose is used to reduce serum ammonia levels in clients with cirrhosis, helping to prevent hepatic encephalopathy. Lactulose works by acidifying the colon, trapping ammonia for excretion. Decreasing blood glucose levels (choice A) is not the primary effect of lactulose. Increasing platelet count (choice C) and lowering serum bilirubin levels (choice D) are not direct effects of lactulose in the management of cirrhosis.

5. When speaking to young parents, the nurse states that lead poisoning is one of the most common preventable health problems affecting children. What condition occurs when the level of lead ingested exceeds the amount that can be absorbed by the bone?

• A. Malnutrition
• B. Anemia
• C. Bone pain
• D. Diarrhea

Correct answer: B

Rationale: The correct answer is B: Anemia. When the amount of lead ingested exceeds the amount that can be absorbed by the bone, it leads to anemia. Malnutrition (Choice A) is a state of inadequate nutrition, not directly related to lead poisoning. Bone pain (Choice C) is a symptom of lead poisoning due to its effects on bones but not directly related to lead ingestion exceeding absorption. Diarrhea (Choice D) is not a direct consequence of lead ingestion exceeding absorption by bones.

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