Nursing Elites

1. A client with acute pancreatitis is receiving total parenteral nutrition (TPN). Which laboratory value should the nurse monitor closely?

• A. Serum potassium
• B. Serum glucose
• C. Serum triglycerides
• D. Serum calcium

Correct answer: C

Rationale: In a client with acute pancreatitis receiving total parenteral nutrition (TPN), the nurse should monitor serum triglycerides closely. Acute pancreatitis can lead to fat malabsorption, making the client susceptible to hypertriglyceridemia. Monitoring serum triglycerides is crucial to prevent complications such as hyperlipidemia. While monitoring serum potassium, glucose, and calcium levels is also essential in various conditions, in this scenario, the primary concern is the risk of developing hypertriglyceridemia due to fat malabsorption.

2. The nurse is caring for a client with a tracheostomy who has thick, tenacious secretions. Which assessment finding is most concerning?

• A. Crepitus around the tracheostomy site
• B. Dry and cracked tracheostomy site
• C. Yellowing of the skin around the tracheostomy site
• D. Mucous plugging of the tracheostomy tube

Correct answer: D

Rationale: Mucous plugging of the tracheostomy tube is the most concerning finding in a client with a tracheostomy and thick secretions. This can lead to airway obstruction, which requires immediate intervention to maintain a patent airway. Crepitus around the tracheostomy site may indicate subcutaneous emphysema but does not pose an immediate threat to the airway. A dry and cracked tracheostomy site may require interventions to promote healing but is not as urgent as mucous plugging. Yellowing of the skin around the tracheostomy site could indicate infection or impaired circulation, which should be addressed but does not pose the same immediate risk as airway obstruction.

3. Following insertion of a LeVeen shunt in a client with cirrhosis of the liver, which assessment finding indicates to the nurse that the shunt is effective?

• A. Decreased abdominal girth
• B. Increased blood pressure
• C. Clear breath sounds
• D. Decreased serum albumin

Correct answer: A

Rationale: The correct answer is A: Decreased abdominal girth. In a client with cirrhosis of the liver, a LeVeen shunt is used to treat ascites, which is the accumulation of fluid in the peritoneal cavity. A decrease in abdominal girth indicates that the shunt is effectively draining the ascitic fluid, relieving the client's abdominal distension. Choice B, increased blood pressure, is incorrect as a LeVeen shunt is not expected to impact blood pressure. Choice C, clear breath sounds, is unrelated to the effectiveness of a LeVeen shunt in managing ascites. Choice D, decreased serum albumin, is also not a direct indicator of the shunt's effectiveness in draining ascitic fluid.

4. What is the first action the nurse should implement for a client admitted with acute pancreatitis?

• A. Administer intravenous fluids as prescribed
• B. Administer pain medication as prescribed
• C. Place the client on NPO status
• D. Assess the client's abdomen for distention

Correct answer: C

Rationale: Placing the client on NPO status is the priority action for a client with acute pancreatitis. This step is crucial to rest the pancreas, prevent pancreatic stimulation, and decrease enzyme production. By withholding oral intake, the digestive system is given a chance to rest and recover. Administering intravenous fluids may be necessary but should come after placing the client on NPO status. Pain medication can be administered once the client is stabilized. Assessing the client's abdomen for distention is important but is not the initial priority in managing acute pancreatitis.

5. A client with rheumatoid arthritis is scheduled to receive a dose of methotrexate. Which laboratory result is most important for the nurse to review before administering the medication?

• A. White blood cell count
• B. Liver function tests
• C. Kidney function tests
• D. Complete blood count

Correct answer: B

Rationale: The correct answer is B: Liver function tests. Before administering methotrexate, it is crucial to review liver function tests due to the medication's potential hepatotoxic effects. Methotrexate can cause liver damage, so monitoring liver function is essential to prevent any serious complications. While white blood cell count, kidney function tests, and complete blood count are important parameters to monitor in certain situations, they are not the most critical before administering methotrexate.

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