Nursing Elites

1. A client with a history of myocardial infarction is admitted with chest pain. Which laboratory value should the nurse monitor closely?

• A. White blood cell count
• B. Serum creatinine
• C. Troponin level
• D. Hemoglobin level

Correct answer: C

Rationale: The correct answer is C: Troponin level. Troponin levels should be closely monitored in a client with chest pain and a history of myocardial infarction to assess for ongoing myocardial injury. Troponin is a specific marker for myocardial damage. Monitoring white blood cell count (choice A) is not directly related to myocardial infarction. Serum creatinine (choice B) is more indicative of renal function rather than cardiac status. Hemoglobin level (choice D) is important but does not directly reflect ongoing myocardial injury.

2. A female client with type 2 diabetes reports that she has been taking her medications as prescribed but her blood glucose levels remain elevated. Which action should the nurse take first?

• A. Check the client's current blood glucose level.
• B. Assess the client's diet and medication adherence.
• C. Review the client's medication list for potential interactions.
• D. Obtain a hemoglobin A1c level.

Correct answer: C

Rationale: The correct action the nurse should take first is to review the client's medication list for potential interactions. This step is crucial as it can help identify any medications that might be contributing to the elevated blood glucose levels. Checking the current blood glucose level (choice A) is important but not the first action to address the ongoing issue. Assessing the client's diet and medication adherence (choice B) is also important, but reviewing the medication list should be the initial step to rule out any drug-related causes. Obtaining a hemoglobin A1c level (choice D) is a valuable assessment but may not address the immediate need to identify potential medication interactions.

3. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which clinical finding requires immediate intervention?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 24 breaths per minute
• C. Use of accessory muscles
• D. Inspiratory crackles

Correct answer: C

Rationale: The correct answer is C. The use of accessory muscles in a client with COPD indicates increased work of breathing and may signal respiratory failure, requiring immediate intervention. This finding suggests that the patient is struggling to breathe effectively. Oxygen saturation of 90% is low but not critically low, while a respiratory rate of 24 breaths per minute is slightly elevated but not as concerning as the increased work of breathing indicated by the use of accessory muscles. Inspiratory crackles may be present in COPD due to underlying conditions like pneumonia but do not require immediate intervention as the use of accessory muscles does.

4. While a child is hospitalized with acute glomerulonephritis, the parents ask why blood pressure readings are taken so often. Which response by the nurse is most accurate?

• A. Elevated blood pressure must be anticipated and identified quickly
• B. Frequent monitoring helps ensure the medication is effective
• C. It is standard protocol for all hospitalized children
• D. We need to monitor for any potential kidney damage

Correct answer: A

Rationale: The correct answer is A: 'Elevated blood pressure must be anticipated and identified quickly.' Acute glomerulonephritis can lead to significant hypertension, making it crucial to monitor blood pressure frequently to promptly identify any elevation. Choice B is incorrect because while monitoring can help assess medication effectiveness, the primary reason for frequent blood pressure checks in this case is to detect elevated blood pressure. Choice C is incorrect as not all hospitalized children require such frequent blood pressure monitoring. Choice D is incorrect as the primary reason for monitoring blood pressure is to detect hypertension, rather than solely focusing on potential kidney damage.

5. Which instruction is most important for a client who receives a new plan of care to treat osteoporosis?

• A. Start a weight-bearing exercise plan.
• B. Increase consumption of foods rich in calcium.
• C. Arrange a bone density test every year.
• D. Stay upright after taking the medication.

Correct answer: D

Rationale: The correct answer is D: 'Stay upright after taking the medication.' This instruction is crucial for clients receiving medications like bisphosphonates to prevent esophageal irritation or erosion. While weight-bearing exercises (choice A) are important for bone health, staying upright after medication intake takes precedence. Increasing calcium-rich foods (choice B) is beneficial but not the most important immediate instruction. Scheduling bone density tests (choice C) is necessary for monitoring osteoporosis but is not as critical as staying upright after medication.

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