Nursing Elites

1. The nurse is caring for a client with acute pancreatitis who is receiving total parenteral nutrition (TPN). Which laboratory value should be monitored closely?

• A. Serum calcium
• B. Serum triglycerides
• C. Serum glucose
• D. Serum triglycerides

Correct answer: B

Rationale: Serum triglycerides should be monitored closely in a client receiving TPN as they may indicate hyperlipidemia, which is a potential complication of TPN. Monitoring serum triglycerides is essential to prevent complications such as hypertriglyceridemia. Serum calcium and glucose levels are also important to monitor in clients receiving TPN, but in this scenario, serum triglycerides take priority due to the risk of hyperlipidemia.

2. A client is being treated with an aminoglycoside antibiotic for a serious gram-negative infection. What nursing action should be included in the plan of care to prevent nephrotoxicity?

• A. Monitor serum creatinine levels daily.
• B. Administer the antibiotic over a longer period of time.
• C. Encourage increased fluid intake.
• D. Restrict dietary protein intake.

Correct answer: A

Rationale: Monitoring serum creatinine levels daily is the essential nursing action to prevent nephrotoxicity from aminoglycoside antibiotics. Aminoglycosides can cause kidney damage, so monitoring serum creatinine levels helps in detecting early signs of nephrotoxicity. Administering the antibiotic over a longer period of time (choice B) does not directly prevent nephrotoxicity. Encouraging increased fluid intake (choice C) is a general good practice but not specifically aimed at preventing nephrotoxicity. Restricting dietary protein intake (choice D) is not a direct preventive measure against aminoglycoside-induced nephrotoxicity.

3. A male client is having abdominal pain after a left femoral angioplasty and stent, and is asking for additional pain medication for right lower quadrant pain (9/10). Two hours ago, he received hydrocodone/acetaminophen 7.5/325 mg. His vital signs are elevated from previous readings: temperature 97.8°F, heart rate 102 beats/minute, respiration 20 breaths/minute. His abdomen is swollen, the groin access site is tender, peripheral pulses are present, but the left is greater than the right. What data is needed to make this report complete?

• A. Client's lungs are clear bilaterally, and oxygen saturation is 97%.
• B. Surgeon needs to see the client immediately to evaluate the situation.
• C. Left peripheral pulses were present only by Doppler pre-procedure.
• D. Client's history includes multiple back surgeries and chronic pain.

Correct answer: B

Rationale: The correct answer is B. In this scenario, the client is experiencing abdominal pain after a left femoral angioplasty and stent, with signs of potential complications such as a swollen abdomen, tenderness at the groin access site, and unequal peripheral pulses. The client's vital signs are also elevated, indicating a worsening condition. Given these findings, the immediate evaluation by the surgeon is crucial to assess for serious complications like internal bleeding or ischemia. Choice A is incorrect as the focus should be on the urgent need for surgical evaluation rather than lung sounds and oxygen saturation. Choice C is irrelevant to the immediate management of the client's current situation. Choice D, while providing background information, is not essential for the urgent intervention required in this case.

4. A male client reports the onset of numbness and tingling in his fingers and around his mouth. Which lab test is important for the nurse to review before contacting the healthcare provider?

• A. Capillary glucose
• B. Urine specific gravity
• C. Serum calcium
• D. White blood cell count

Correct answer: C

Rationale: The correct answer is C: Serum calcium. Numbness and tingling in the fingers and around the mouth are indicative of hypocalcemia. Serum calcium levels should be reviewed as they play a crucial role in diagnosing and managing hypocalcemia. Option A, capillary glucose, is not relevant to the symptoms described. Option B, urine specific gravity, is not typically used to assess numbness and tingling. Option D, white blood cell count, is unrelated to the symptoms presented by the client.

5. A client with newly diagnosed peptic ulcer disease is being taught about lifestyle modifications. Which client statement indicates that further teaching is needed?

• A. ‘I should avoid eating spicy foods to prevent irritation of my ulcer.’
• B. ‘I should take my antacids regularly, even if I don’t have symptoms.’
• C. ‘I should avoid smoking to prevent exacerbation of my symptoms.’
• D. ‘I should avoid drinking alcohol to prevent irritation of my ulcer.’

Correct answer: D

Rationale: The corrected question assesses the client's understanding of lifestyle modifications for peptic ulcer disease. Choice D, 'I should avoid drinking alcohol to prevent irritation of my ulcer,' is the correct answer. This statement demonstrates that the client has a good grasp of the teaching provided, as alcohol can indeed irritate peptic ulcers. Choices A, B, and C are all accurate statements that reflect appropriate understanding of managing peptic ulcer disease and do not indicate a need for further teaching.

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