Nursing Elites

1. In evaluating a 10-year-old child with meningitis suspected of having diabetes insipidus, which finding is indicative of diabetes insipidus?

• A. Decreased urine specific gravity.
• B. Elevated urine glucose.
• C. Decreased serum potassium.
• D. Increased serum sodium.

Correct answer: A

Rationale: Diabetes insipidus is characterized by the kidneys' inability to concentrate urine, leading to decreased urine specific gravity. This results in the excretion of large volumes of dilute urine, causing a decrease in urine specific gravity. Therefore, when evaluating a suspected case of diabetes insipidus, a finding of decreased urine specific gravity is indicative of this condition.

2. A patient with gout is prescribed allopurinol. What should the nurse include in the patient teaching?

• A. Take the medication with food.
• B. Increase intake of high-purine foods.
• C. Limit fluid intake to 1 liter per day.
• D. Expect immediate pain relief.

Correct answer: A

Rationale: When educating a patient prescribed allopurinol for gout, the nurse should emphasize taking the medication with food to reduce the risk of gastrointestinal upset. It is important to instruct the patient to maintain adequate hydration by consuming plenty of fluids, preferably water, to help prevent kidney stone formation and facilitate the drug's effectiveness. Allopurinol does not provide immediate pain relief but rather works to lower uric acid levels over time, reducing the frequency of gout attacks. Choices B and C are incorrect as increasing high-purine foods can exacerbate gout symptoms, and limiting fluid intake to 1 liter per day is not recommended for gout patients who should maintain good hydration. Choice D is incorrect because allopurinol does not offer immediate pain relief.

3. A client with chronic kidney disease is prescribed a low-protein diet. Which laboratory result should the nurse monitor to evaluate the effectiveness of the diet?

• A. Blood urea nitrogen (BUN)
• B. Serum potassium
• C. Serum calcium
• D. Creatinine clearance

Correct answer: A

Rationale: Blood urea nitrogen (BUN) levels should be monitored to assess the effectiveness of a low-protein diet in clients with chronic kidney disease. BUN levels reflect the breakdown of protein in the body, and a low-protein diet aims to reduce BUN levels to lessen the workload on the kidneys. Therefore, monitoring BUN levels is crucial in managing kidney function and evaluating the impact of dietary modifications. Serum potassium, serum calcium, and creatinine clearance are important parameters to monitor in clients with chronic kidney disease, but they are not specifically indicative of the effectiveness of a low-protein diet. Serum potassium levels are crucial in assessing electrolyte balance, serum calcium levels are important for bone health and nerve function, and creatinine clearance reflects kidney function overall, not just the impact of a low-protein diet.

4. A client with chronic obstructive pulmonary disease (COPD) is experiencing respiratory distress. Which intervention should the nurse implement first?

• A. Administer bronchodilators as prescribed.
• B. Encourage pursed-lip breathing.
• C. Position the client in a high Fowler's position.
• D. Obtain a stat arterial blood gas (ABG) sample.

Correct answer: C

Rationale: In a client with COPD experiencing respiratory distress, the priority intervention should be to position the client in a high Fowler's position. This position helps optimize lung expansion, improve oxygenation, and reduce the work of breathing. Administering bronchodilators and encouraging pursed-lip breathing are important interventions but positioning the client to enhance respiratory function takes precedence in this situation. Obtaining an ABG sample may provide valuable information but is not the initial priority when addressing respiratory distress.

5. A 70-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?

• A. Gallstones
• B. Hepatitis
• C. Pancreatic cancer
• D. Primary biliary cirrhosis

Correct answer: C

Rationale: The presentation of a 70-year-old man with weight loss, jaundice, a palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels is highly suggestive of pancreatic cancer. This clinical scenario, known as Courvoisier's sign, points towards a pancreatic malignancy due to biliary obstruction. Gallstones could cause similar symptoms but would typically not present with a palpable mass. Hepatitis usually does not present with a palpable mass and would have different laboratory findings. Primary biliary cirrhosis typically presents differently with chronic cholestasis without the presence of a palpable mass or a pancreatic lesion.

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