Nursing Elites

1. An adult female client has undergone a routine health screening in the clinic. Which of the following values indicates to the nurse who receives the report of the client’s laboratory work that the client’s hematocrit is normal?

• A. 10%
• B. 22%
• C. 30%
• D. 43%

Correct answer: D

Rationale: The normal hematocrit for an adult female client ranges from 35% to 47%. A hematocrit value of 43% falls within this normal range, indicating normal levels of red blood cells. Choices A, B, and C are low hematocrit values and are considered below the normal range for adult females, signifying potential anemia or other health issues.

2. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?

• A. A serum drug level greater than the MEC ensures that the drug is bacteriostatic.
• B. A serum drug level greater than the MEC broadens the spectrum of the drug.
• C. A serum drug level greater than the MEC helps eradicate bacterial infections.
• D. A serum drug level greater than the MEC increases the therapeutic index.

Correct answer: C

Rationale: The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Therefore, choice A is incorrect. Broadening the spectrum of a drug refers to its range of activity against different microorganisms, which is not directly related to MEC. Thus, choice B is incorrect. Increasing the therapeutic index involves maximizing the effectiveness of a drug while minimizing its toxicity, which is not specifically related to MEC. Therefore, choice D is also incorrect.

3. A client is receiving intermittent bolus feedings via a nasogastric tube. In which position should the nurse place the client once the feeding is complete?

• A. Supine
• B. Head of bed flat
• C. Left lateral position
• D. Head of bed elevated 30 to 45 degrees

Correct answer: B

Rationale: After intermittent bolus feedings through a nasogastric tube, the correct position for the client is to keep the head of the bed flat. This position helps prevent vomiting and aspiration. Placing the client in a supine position (choice A) can increase the risk of aspiration. The left lateral position (choice C) is not typically used after nasogastric tube feedings. Elevating the head of the bed 30 to 45 degrees (choice D) is suitable for continuous tube feedings to reduce the risk of aspiration, but for intermittent bolus feedings, keeping the head of the bed flat is preferred to prevent regurgitation and aspiration.

4. A client with diabetes mellitus who is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. What intervention should the nurse recommend to help prevent hypoglycemia while the client is sleeping?

• A. Eat a bedtime snack.
• B. Avoid physical activity.
• C. Take half the usual dose of insulin.
• D. Discontinue insulin until the next meal.

Correct answer: A

Rationale: Eating a bedtime snack is the most appropriate intervention to prevent hypoglycemia during the night when NPH insulin peaks. This snack helps maintain blood glucose levels and counteracts the risk of hypoglycemia. Avoiding physical activity is not recommended as it can further lower blood sugar levels. Taking half the usual dose of insulin can lead to inadequate control of blood sugar levels. Discontinuing insulin until the next meal can result in uncontrolled hyperglycemia, especially during the peak action of NPH insulin.

5. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection the previous day and notes that 1000 ml of gastric secretions were collected in the last 4 hours. What condition is the client at risk for developing?

• A. Metabolic alkalosis
• B. Hyperkalemia
• C. Metabolic acidosis
• D. Hypoglycemia

Correct answer: A

Rationale: The correct answer is A: Metabolic alkalosis. Loss of gastric secretions, which contain stomach acid, can lead to metabolic alkalosis. Excessive loss of acid results in an increase in the blood pH, leading to alkalosis. Hyperkalemia (B) is an elevated potassium level and is not directly related to the loss of gastric secretions. Metabolic acidosis (C) is an acid-base imbalance characterized by low pH and bicarbonate levels, which is the opposite of what would occur with the loss of gastric secretions. Hypoglycemia (D) is low blood sugar and is not typically associated with the scenario described in the question.

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