Nursing Elites

1. Erythropoietin used to treat anemia in clients with renal failure should be given in conjunction with:

• A. iron, folic acid, and B12.
• B. an increase in protein in the diet.
• C. vitamins A and C.
• D. an increase in calcium in the diet.

Correct answer: A

Rationale: Erythropoietin is necessary for red blood cell (RBC) production, and in clients with renal failure who lack endogenous erythropoietin, exogenous erythropoietin is administered. However, for erythropoietin to effectively stimulate RBC production, adequate levels of iron, folic acid, and vitamin B12 are crucial. These nutrients are essential for RBC synthesis and maturation. Therefore, the correct answer is to give iron, folic acid, and B12 with erythropoietin. Choice B, an increase in protein in the diet, is not necessary for RBC production and may exacerbate uremia in clients with renal failure. Choices C and D, vitamins A and C, and an increase in calcium in the diet, respectively, are not directly related to RBC production and are not required to enhance the effectiveness of erythropoietin.

2. Which of the following observations is most important when assessing a client's breathing?

• A. presence of breathing and pulse rate
• B. breathing pattern and adequacy of breathing
• C. presence of breathing and adequacy of breathing
• D. patient position and adequacy of breathing

Correct answer: C

Rationale: The correct answer is the presence of breathing and adequacy of breathing. It is crucial not only to confirm that the client is breathing but also to ensure that the breathing is adequate for proper oxygenation. Choices A, B, and D are incorrect because while pulse rate, breathing pattern, and patient position are relevant aspects to consider, the most critical observations in assessing a client's breathing are the presence and adequacy of breathing.

3. A newborn baby exhibits a reflex that includes hand opening, abducted, and extended extremities following a jarring motion. Which of the following correctly identifies the reflex?

• A. ATNR reflex
• B. Startle reflex
• C. Grasping reflex
• D. Moro reflex

Correct answer: D

Rationale: The Moro reflex, also known as the startle reflex, is the correct answer. This reflex is characterized by the baby's response to a sudden head movement or loud noise, causing them to open their hands, extend their arms, and then bring them back towards their body. The characteristics mentioned in the question - hand opening, abducted, and extended extremities following a jarring motion - align with the Moro reflex. The asymmetrical tonic neck reflex (ATNR) involves the head turning to one side with extension of the same side's arm and leg, not the described characteristics. The grasping reflex involves the baby's response to touch on the palm, causing them to grasp an object. While the Moro reflex is often referred to as the startle reflex due to its response to sudden stimuli, the specific characteristics described in the question match the Moro reflex.

4. In conducting a community health fair for a group of middle-aged citizens, which statement should the nurse emphasize in reducing the risk of coronary heart disease?

• A. Participate in at least 30 minutes of moderate physical activity 3 to 5 days per week.
• B. Engage in an aerobic exercise class every day.
• C. Limit your alcohol intake to a moderate level.
• D. The best way to lose weight is to follow a balanced diet.

Correct answer: B

Rationale: Engaging in an aerobic exercise class every day is crucial in reducing the risk of coronary heart disease. Aerobic exercises help keep the heart in shape, lower blood pressure, and improve cholesterol levels. It is recommended to participate in at least 150 minutes of moderate-intensity aerobic exercise per week, which can be achieved by engaging in aerobic exercise daily. Choice A has been corrected to emphasize the frequency required to significantly reduce the risk of coronary heart disease. Choice C has been modified to suggest moderation in alcohol intake, as excessive alcohol consumption is harmful. Choice D is also incorrect as a balanced diet, not specifically high-protein, high-fat, is recommended to reduce the risk of coronary heart disease and maintain a healthy weight.

5. The PN is caring for a client with diabetes insipidus. The nurse can expect the lab work to show:

• A. elevated urine osmolarity and elevated serum osmolarity.
• B. decreased urine osmolarity and decreased serum osmolarity.
• C. elevated urine osmolarity and decreased serum osmolarity.
• D. decreased urine osmolarity and elevated serum osmolarity.

Correct answer: D

Rationale: In diabetes insipidus, the pituitary releases too much antidiuretic hormone (ADH), causing the client to produce a large amount of dilute urine (decreased osmolarity) and leading to dehydration (elevated serum osmolarity). Therefore, the correct answer is decreased urine osmolarity and elevated serum osmolarity. Choice C, elevated urine osmolarity and decreased serum osmolarity, is incorrect for diabetes insipidus, as it is more characteristic of syndrome of inappropriate ADH (SIADH). Choices A and B, elevated urine osmolarity and elevated serum osmolarity, and decreased urine osmolarity and decreased serum osmolarity, respectively, are generally not seen in diabetes insipidus, as urine and serum osmolarity typically move in opposite directions in this condition.

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