Nursing Elites

1. A 70-year-old woman presents with fatigue, anorexia, and weight loss. She has noticed darkening of her skin, particularly in sun-exposed areas. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?

• A. Cushing's syndrome
• B. Addison's disease
• C. Hypothyroidism
• D. Pheochromocytoma

Correct answer: B

Rationale: The combination of symptoms such as fatigue, anorexia, weight loss, hyperpigmentation of the skin, along with hyponatremia, hyperkalemia, and low cortisol levels, points towards Addison's disease. This condition is characterized by adrenal insufficiency, leading to a deficiency in cortisol and aldosterone production.

2. A client who is receiving heparin therapy has an activated partial thromboplastin time (aPTT) of 90 seconds. What action should the nurse take?

• A. Increase the heparin infusion rate.
• B. Notify the healthcare provider.
• C. Apply pressure to the injection site.
• D. Administer protamine sulfate.

Correct answer: B

Rationale: An activated partial thromboplastin time (aPTT) of 90 seconds is elevated, indicating a risk of bleeding. The appropriate action for the nurse is to notify the healthcare provider. Increasing the heparin infusion rate can further elevate the aPTT, leading to an increased risk of bleeding. Applying pressure to the injection site is not relevant in this situation. Administering protamine sulfate is used to reverse the effects of heparin in cases of overdose or bleeding, but it is not the initial action for an elevated aPTT.

3. A client with type 1 diabetes mellitus is admitted with hyperglycemia. Which laboratory result requires the most immediate intervention?

• A. Serum glucose of 350 mg/dL.
• B. Serum potassium of 2.8 mEq/L.
• C. Serum sodium of 136 mEq/L.
• D. Serum bicarbonate of 20 mEq/L.

Correct answer: B

Rationale: A serum potassium level of 2.8 mEq/L is critically low and can cause cardiac arrhythmias, requiring immediate intervention. Hypokalemia is a life-threatening condition that needs prompt correction to prevent serious complications. High serum glucose levels (choice A) are a concern in diabetes but do not pose an immediate life-threatening risk compared to severe hypokalemia. Serum sodium (choice C) and serum bicarbonate levels (choice D) are within normal ranges and do not require immediate intervention.

4. A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?

• A. Serum qualitative test for H. pylori
• B. Refer for endoscopy
• C. Obtain an upper GI series
• D. Treat her for H. pylori infection

Correct answer: A

Rationale: The patient presents with dyspepsia, described as an intermittent burning sensation in the epigastrium, sometimes related to eating. In individuals under 45 years without warning signs such as anemia, weight loss, or dysphagia, a serum qualitative test for H. pylori is recommended to document H. pylori infection, especially if the patient has not been previously treated. It's important to note that a serum IgG can remain positive post-eradication. If H. pylori-positive patients do not respond to treatment, an endoscopy would be the next step for evaluation. An upper GI series is less sensitive than endoscopy in detecting lesions of the upper GI tract and cannot specifically detect H. pylori. Empiric therapy for H. pylori without confirmation is not recommended.

5. The client with newly diagnosed hypertension is being taught about lifestyle modifications. Which recommendation should be made?

• A. Increase your intake of saturated fats.
• B. Limit your alcohol intake to two drinks per day.
• C. Engage in at least 150 minutes of moderate exercise per week.
• D. Use table salt liberally to season your food.

Correct answer: C

Rationale: Engaging in at least 150 minutes of moderate exercise per week is a key lifestyle modification recommended for individuals with hypertension. Regular exercise helps manage blood pressure, improve cardiovascular health, and overall well-being. It is important for the client to adopt a healthy lifestyle to control hypertension and reduce the risk of complications.

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