Nursing Elites

1. The LPN is checking for residual before administering enteral feeding through a PEG tube. Which of these steps is incorrect?

• A. The LPN elevates the head of the bed by at least 30 degrees.
• B. If the residual is greater than 200mL, the LPN should not administer the enteral feeding.
• C. The LPN should discard the residual before administering the tube feeding.
• D. The residual pH level is tested to ensure appropriate placement.

Correct answer: C

Rationale: The incorrect step is choice C. The residual should be discarded before administering the tube feeding. Discarding the residual is essential to prevent contamination and ensure accurate measurement of the enteral feeding. Elevating the head of the bed by at least 30 degrees (choice A) is correct as it helps prevent aspiration during feeding. Testing the pH level of the residual (choice D) ensures proper placement of the tube. Withholding feeding if the residual is greater than 200mL (choice B) is crucial to prevent overfeeding, making this statement correct.

2. What spinal change occurring with pregnancy alters mobility?

• A. Scoliosis.
• B. Kyphosis.
• C. Lordosis.
• D. Ankylosing spondylitis.

Correct answer: C

Rationale: The correct answer is 'Lordosis.' During pregnancy, the enlarging uterus places increased weight on the spine, causing an exaggerated inward curvature known as lordosis. This change alters mobility by shifting the center of gravity forward, leading to a compensatory change in posture. Scoliosis (choice A) is a sideways curvature of the spine, not typically associated with pregnancy. Kyphosis (choice B) is an exaggerated outward curvature of the spine, while ankylosing spondylitis (choice D) is a chronic inflammatory condition affecting the spine, neither of which are directly related to the spinal changes seen in pregnancy.

3. Which of the following tests is commonly performed on newborns with jaundice?

• A. blood urea nitrogen
• B. magnesium
• C. bilirubin
• D. prolactin

Correct answer: C

Rationale: The correct answer is C: bilirubin. A high bilirubin level is found in newborns with hepatic immaturity, leading to jaundice. Testing bilirubin levels is crucial in diagnosing and monitoring jaundice in newborns. Choices A, B, and D (blood urea nitrogen, magnesium, and prolactin) are not commonly performed tests for evaluating jaundice in newborns. Blood urea nitrogen is a measure of kidney function, magnesium levels are usually checked in metabolic disorders, and prolactin is a hormone related to lactation, none of which are directly relevant to assessing jaundice in newborns.

4. A client with which of the following conditions is at risk for developing a high ammonia level?

• A. renal failure
• B. psoriasis
• C. lupus
• D. cirrhosis

Correct answer: D

Rationale: A client with cirrhosis is at risk for developing a high ammonia level due to impaired liver function. The liver normally converts ammonia into urea for excretion. In cirrhosis, this process is compromised, leading to elevated ammonia levels in the blood. Renal failure, psoriasis, and lupus do not typically cause high ammonia levels. Renal failure affects kidney function, while psoriasis and lupus are autoimmune conditions that do not directly impact ammonia metabolism.

5. Which fetal heart monitor pattern can indicate cord compression?

• A. variable decelerations
• B. early decelerations
• C. bradycardia
• D. tachycardia

Correct answer: A

Rationale: Variable decelerations can indicate cord compression as they are caused by umbilical cord compression or prolapse. This pattern shows an abrupt decrease in heart rate with an erratic shape, often resembling a V or W. Early decelerations (choice B) are typically caused by head compression during contractions and are considered benign. Bradycardia (choice C) is a consistent low heart rate below 110 bpm and is not specific to cord compression. Tachycardia (choice D) is an abnormally high heart rate above 160 bpm and is not associated with cord compression.

Similar Questions