Nursing Elites

1. The nurse is analyzing laboratory values for the assigned clients. Which finding, based on the client's medical history, indicates the need for immediate follow-up?

• A. Client with chronic kidney disease and serum creatinine of 1.6 mg/dL
• B. Client with diabetes mellitus and a glycosylated hemoglobin A (HbA1c) of 7.0%
• C. Client with heart failure and a B-type natriuretic peptide (BNP) of 140 pg/mL
• D. Client who is male and has anemia with hemoglobin of 16.5 g/dL and hematocrit of 45%

Correct answer: B

Rationale: An HbA1c of 7.0% in a client with diabetes mellitus indicates poor long-term glucose control, necessitating immediate follow-up. Elevated HbA1c levels suggest a higher average blood sugar over the past 2-3 months, increasing the risk of complications associated with diabetes. Choices A, C, and D do not require immediate follow-up based solely on the provided information. A serum creatinine of 1.6 mg/dL in a client with chronic kidney disease, a BNP of 140 pg/mL in a client with heart failure, and hemoglobin of 16.5 g/dL and hematocrit of 45% in a male client with anemia are within acceptable ranges or do not indicate an urgent need for intervention.

2. During a synchronized cardioversion on a client in atrial fibrillation, when the machine is activated and there is a pause, what action should the nurse take?

• A. Wait until the machine discharges
• B. Shout “all clear” and don’t touch the bed
• C. Make sure the client is all right
• D. Increase the joules and re-discharge

Correct answer: B

Rationale: The correct action for the nurse to take when there is a pause after activating the machine for synchronized cardioversion on a client in atrial fibrillation is to shout “all clear” and not touch the bed. This step is crucial to ensure the safety of everyone present by warning them that the machine will discharge, preventing anyone from being inadvertently shocked. Waiting for the machine to discharge (choice A) is not recommended as it can lead to accidental injury. While ensuring the client is all right (choice C) is important, the immediate focus should be on safety during the procedure. Increasing the joules and re-discharging (choice D) without assessing the situation can pose risks to the client and the healthcare team.

3. What is the COMMZ level hospital whose principal mission is to treat and rehabilitate those patients who can return to duty within the stated theater evacuation policy?

• A. FSB
• B. CSH
• C. GH
• D. FH

Correct answer: C

Rationale: The correct answer is C: GH (General Hospital). General Hospitals have the principal mission of treating and rehabilitating patients who can return to duty within the theater evacuation policy. FSB (Forward Surgical Hospital), CSH (Combat Support Hospital), and FH (Field Hospital) do not focus on treating and rehabilitating patients for duty within the theater evacuation policy, making them incorrect choices.

4. A patient with a history of peptic ulcer disease should avoid which medication?

• A. Acetaminophen
• B. Antacids
• C. Nonsteroidal anti-inflammatory drugs
• D. Antihistamines

Correct answer: C

Rationale: Patients with a history of peptic ulcer disease should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) because they can worsen peptic ulcers. NSAIDs inhibit the production of prostaglandins, which help protect the stomach lining. Acetaminophen (Choice A) is a safer alternative for pain relief in patients with peptic ulcers. Antacids (Choice B) can actually help in symptom relief by neutralizing stomach acid. Antihistamines (Choice D) are not known to worsen peptic ulcers and are generally safe for use in patients with this condition.

5. Which lipoprotein carries cholesterol from tissues to the liver for excretion?

• A. Very low-density lipoprotein
• B. Intermediate-density lipoprotein
• C. Low-density lipoprotein
• D. High-density lipoprotein

Correct answer: D

Rationale: The correct answer is D, High-density lipoprotein (HDL). HDL is known as 'good' cholesterol because it helps transport excess cholesterol from tissues back to the liver for removal from the body. Very low-density lipoprotein (VLDL) (choice A) and intermediate-density lipoprotein (choice B) are involved in transporting triglycerides. Low-density lipoprotein (LDL) (choice C) is known as 'bad' cholesterol as it can deposit cholesterol in the walls of arteries.

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