Nursing Elites

1. The client with a history of heart failure is taking furosemide (Lasix). Which laboratory result should the nurse monitor closely?

• A. Serum sodium.
• B. Serum potassium.
• C. Serum calcium.
• D. Serum magnesium.

Correct answer: B

Rationale: Furosemide (Lasix) is a loop diuretic that can lead to potassium loss, causing hypokalemia. Monitoring serum potassium levels is crucial to prevent complications such as cardiac dysrhythmias associated with low potassium levels.

2. The nurse is caring for a client with hyperthyroidism. Which intervention should the nurse implement to manage the client's condition?

• A. Provide a high-calorie diet.
• B. Encourage frequent rest periods.
• C. Restrict fluid intake.
• D. Administer a stool softener.

Correct answer: B

Rationale: Encouraging frequent rest periods is essential in managing hyperthyroidism as it helps address the fatigue and hypermetabolic state commonly associated with this condition. Rest is crucial to support the body's recovery and reduce the stress on the thyroid gland. While nutrition is important in managing hyperthyroidism, providing a high-calorie diet is not the priority intervention. Restricting fluid intake is not typically necessary unless there are specific indications such as heart failure. Administering a stool softener is not directly related to managing hyperthyroidism.

3. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be

• A. Antibiotic therapy with ciprofloxacin and metronidazole
• B. Referral for urgent colonoscopy
• C. Referral to a surgeon for immediate hemicolectomy
• D. Barium enema

Correct answer: A

Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

4. A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?

• A. Esophageal stricture
• B. Esophageal cancer
• C. Achalasia
• D. Peptic ulcer disease

Correct answer: B

Rationale: In this scenario, the patient's presentation of progressive dysphagia to both solids and liquids, along with significant weight loss, is concerning for esophageal cancer. The history of chronic heartburn further raises suspicion as chronic gastroesophageal reflux disease is a risk factor for the development of esophageal adenocarcinoma. Esophageal stricture could cause dysphagia but is less likely to be associated with significant weight loss. Achalasia typically presents with dysphagia to solids more than liquids and does not commonly cause weight loss. Peptic ulcer disease is less likely to lead to progressive dysphagia and significant weight loss compared to esophageal cancer.

5. For a patient with asthma, what is the primary purpose of prescribing montelukast?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Thin respiratory secretions
• D. Suppress cough

Correct answer: B

Rationale: Montelukast, a leukotriene receptor antagonist, is primarily prescribed to prevent asthma attacks. It works by reducing inflammation and bronchoconstriction in the airways, thereby helping to control asthma symptoms and prevent exacerbations.

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