Nursing Elites

1. When assessing a client receiving total parenteral nutrition (TPN), which laboratory value is most important for the nurse to monitor regularly?

• A. Albumin
• B. Calcium
• C. Glucose
• D. Alkaline phosphatase

Correct answer: C

Rationale: The most important laboratory value to monitor regularly in clients receiving total parenteral nutrition (TPN) is glucose. TPN solutions contain high concentrations of glucose, which can lead to hyperglycemia. Monitoring glucose levels is crucial to detect and prevent hyperglycemia, a common complication associated with TPN administration. Albumin (Choice A) levels are not typically affected by TPN administration. Calcium (Choice B) and alkaline phosphatase (Choice D) are not directly impacted by TPN and are not the primary values to monitor in TPN therapy.

2. The nurse is informed during shift report that a client is experiencing occasional ventricular dysrhythmias. The nurse reviews the client's laboratory results, recalling that which electrolyte imbalance could be responsible for this development?

• A. Hypokalemia
• B. Hypernatremia
• C. Hypochloremia
• D. Hypercalcemia

Correct answer: A

Rationale: Hypokalemia, which is low potassium levels, can disrupt the normal electrical activity of the heart and lead to ventricular dysrhythmias. Potassium plays a crucial role in maintaining the heart's rhythm, and a deficiency can result in dangerous heart rhythm abnormalities. Hypernatremia (Choice B), which is high sodium levels, does not directly impact heart rhythm. Hypochloremia (Choice C), which is low chloride levels, is not typically associated with ventricular dysrhythmias. Hypercalcemia (Choice D), which is high calcium levels, is not a common cause of ventricular dysrhythmias.

3. A client with a history of chronic heart failure is being discharged. Which instruction should the nurse include in the discharge teaching?

• A. Weigh yourself daily and report a weight gain of 2 pounds or more in a day.
• B. Restrict fluid intake to 2000 mL per day.
• C. Increase your salt intake to prevent electrolyte imbalance.
• D. Exercise vigorously at least three times a week.

Correct answer: A

Rationale: The correct answer is to weigh yourself daily and report a weight gain of 2 pounds or more in a day. This instruction is crucial because daily weights help in early detection of fluid retention, a common complication in heart failure. Monitoring weight is essential for managing heart failure and preventing exacerbations. Choice B is incorrect because fluid restriction may be necessary in some cases of heart failure, but a general limit of 2000 mL per day is not appropriate without individual assessment. Choice C is incorrect as increasing salt intake can worsen fluid retention and exacerbate heart failure symptoms. Choice D is incorrect because while exercise is beneficial for heart health, vigorous exercise may not be suitable for all heart failure patients and should be tailored to their specific condition.

4. When preparing to administer medication to a client, what action should the nurse take first?

• A. Verify the client's identity.
• B. Check the medication expiration date.
• C. Review the client's medical history.
• D. Obtain the client's vital signs.

Correct answer: A

Rationale: Verifying the client's identity is the initial and most critical step in medication administration. It is crucial to confirm that the right medication is being given to the correct patient. Checking the client's identity helps prevent medication errors and ensures patient safety. Checking the medication expiration date (choice B) is important but should come after verifying the client's identity. Reviewing the client's medical history (choice C) is valuable but not the first step in medication administration. Obtaining the client's vital signs (choice D) is essential in some situations but is usually not the first action needed before administering medication.

5. The nurse is assisting with the care of a client who is on a continuous heparin infusion for deep vein thrombosis (DVT). Which laboratory test should the nurse monitor to evaluate the effectiveness of the therapy?

• A. Prothrombin time (PT)
• B. Activated partial thromboplastin time (aPTT)
• C. International normalized ratio (INR)
• D. Platelet count

Correct answer: B

Rationale: To evaluate the effectiveness of heparin therapy in a client with DVT, the nurse should monitor the activated partial thromboplastin time (aPTT). The aPTT test helps ensure that the dose of heparin is within the therapeutic range, which is essential for preventing clot formation or excessive bleeding. Monitoring aPTT is crucial in managing patients on heparin therapy to maintain the delicate balance between preventing thrombosis and avoiding hemorrhage. Prothrombin time (PT) and International normalized ratio (INR) are more indicative of warfarin therapy effectiveness, not heparin. Platelet count assesses platelet levels and function, not the effectiveness of heparin therapy for DVT.

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