Nursing Elites

1. An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation?

• A. Pallor
• B. Edema
• C. Confusion
• D. Restlessness

Correct answer: B

Rationale: The correct answer is B: Edema. The normal range for total protein is 6.4 to 8.3 g/dL. Low serum protein levels cause a decrease in plasma oncotic pressure and allow fluid to remain in interstitial tissues, causing edema. Confusion, restlessness, and pallor are not associated with low serum protein levels. Pallor is more commonly seen in anemia, confusion and restlessness may be related to other issues like electrolyte imbalances or neurological conditions.

2. What is the first action the nurse should take when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter?

• A. Notify the health care provider.
• B. Offer reassurance to the patient.
• C. Auscultate the patient’s breath sounds
• D. Give the prescribed PRN morphine sulfate IV

Correct answer: C

Rationale: The correct first action for the nurse to take when a patient complains of acute chest pain and dyspnea after the insertion of a centrally inserted IV catheter is to auscultate the patient's breath sounds. This is important to assess for any potential complications such as embolism or pneumothorax, which can present with such symptoms. Auscultation can provide immediate information on the patient's respiratory status and guide further interventions. Notifying the health care provider, offering reassurance, or administering morphine should only be considered after assessing the patient's condition through auscultation.

3. The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse take next?

• A. Monitor ionized calcium level.
• B. Give oral calcium citrate tablets.
• C. Check parathyroid hormone level.
• D. Administer vitamin D supplements.

Correct answer: A

Rationale: This patient with chronic malnutrition is likely to have a low serum albumin level, which will affect the total serum calcium. A more accurate reflection of calcium balance is the ionized calcium level. Most of the calcium in the blood is bound to protein (primarily albumin). Alterations in serum albumin levels affect the interpretation of total calcium levels. Low albumin levels result in a drop in the total calcium level, although the level of ionized calcium is not affected. The nurse should monitor the ionized calcium level to get a clearer picture of the patient's calcium status. Giving oral calcium citrate tablets, checking parathyroid hormone level, or administering vitamin D supplements may be necessary based on the ionized calcium results, but they are not the immediate next step in assessment and management.

4. A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction and is complaining of anxiety and incisional pain. The patient’s respiratory rate is 32 breaths/minute and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first?

• A. Discontinue the nasogastric suction.
• B. Give the patient the PRN IV morphine sulfate 4 mg.
• C. Notify the health care provider about the ABG results.
• D. Teach the patient how to take slow, deep breaths when anxious.

Correct answer: B

Rationale: The patient’s respiratory alkalosis is caused by the increased respiratory rate associated with pain and anxiety. The nurse’s first action should be to medicate the patient for pain. Although the nasogastric suction may contribute to the alkalosis, it is not appropriate to discontinue the tube when the patient needs gastric suction. The health care provider may be notified about the ABGs but is likely to instruct the nurse to medicate for pain. The patient will not be able to take slow, deep breaths when experiencing pain.

5. When assessing a male client, the nurse finds that he is fatigued, and is experiencing muscle weakness, leg cramps, and cardiac dysrhythmias. Based on these findings, the nurse plans to check the client's laboratory values to validate the existence of which?

• A. Hyperphosphatemia
• B. Hypocalcemia
• C. Hypermagnesemia
• D. Hypokalemia

Correct answer: D

Rationale: The correct answer is D, Hypokalemia. Generalized weakness, muscle weakness, leg cramps, and cardiac dysrhythmias are manifestations of hypokalemia. Checking the potassium level is essential in this case. Hypocalcemia typically presents with facial muscle spasms, not the symptoms mentioned. Hypermagnesemia does not typically cause the symptoms described. It's important to note that orange juice is high in potassium and would be advisable to drink if the patient was hypokalemic. Loose stools are more commonly associated with hyperkalemia, not hypokalemia.

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