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. Why is a client with ascites scheduled for a paracentesis procedure?

• A. To diagnose liver disease
• B. To relieve abdominal pressure
• C. To assess kidney function
• D. To reduce blood pressure

Correct answer: B

Rationale: The correct answer is B: "To relieve abdominal pressure." Paracentesis is performed to drain accumulated fluid in the peritoneal cavity, providing symptomatic relief for clients with ascites. Choice A is incorrect because paracentesis is not a diagnostic procedure for liver disease. Choice C is incorrect as assessing kidney function would typically involve different procedures. Choice D is incorrect as paracentesis does not directly impact blood pressure.

3. Why is a low-protein diet recommended for a client with hepatic encephalopathy?

• A. Hyperglycemia
• B. Hypoglycemia
• C. Increased ammonia levels
• D. Electrolyte imbalance

Correct answer: C

Rationale: A low-protein diet is recommended for clients with hepatic encephalopathy to reduce ammonia levels. Ammonia, a byproduct of protein metabolism, can accumulate in the blood due to impaired liver function. Elevated ammonia levels can lead to worsening hepatic encephalopathy, a condition characterized by cognitive and neurological disturbances. Therefore, by limiting protein intake, the production of ammonia is reduced, thereby helping to manage hepatic encephalopathy. Choices A, B, and D are incorrect because hepatic encephalopathy is not primarily related to hyperglycemia, hypoglycemia, or electrolyte imbalance. The focus is on reducing ammonia levels to improve the condition.

4. A 75-year-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?

• A. Drug Abuse Screening Test (DAST-10)
• B. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
• C. Screening Test-Geriatric Version (SMAST-G)
• D. Mini-Mental State Examination

Correct answer: C

Rationale: The most appropriate tool for the nurse to use during the admission assessment of a 75-year-old patient admitted for pancreatitis is the Screening Test-Geriatric Version (SMAST-G). Since alcohol abuse is a common factor associated with pancreatitis, screening for alcohol use is crucial. The SMAST-G is a validated short-form alcoholism screening instrument tailored for older adults. If the patient screens positively on the SMAST-G, then the CIWA-Ar would be useful for further assessment. The Drug Abuse Screening Test (DAST-10) provides information on substance use in general, not specific to alcohol. The Mini-Mental State Examination is used to assess cognitive function, not alcohol abuse.

5. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

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