Nursing Elites

1. A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

• A. Osmolarity
• B. Glucose
• C. Albumin
• D. Platelets

Correct answer: B

Rationale: The correct answer is B: Glucose. Hydrocortisone can lead to increased blood glucose levels, so monitoring glucose is crucial to assess for hyperglycemia, a common side effect of corticosteroid therapy. Monitoring osmolarity (choice A) is not typically indicated in this scenario. Albumin (choice C) and platelets (choice D) are not directly affected by hydrocortisone therapy and are not the primary focus of monitoring in this case.

2. A client admitted to a surgical unit is being evaluated for an intestinal obstruction. The HCP prescribes an NG tube to be inserted and placed on intermittent low wall suction. Which intervention should the nurse implement to facilitate proper tube placement?

• A. Soak the NG tube in warm water
• B. Insert the tube with the client's head tilted back
• C. Apply suction while inserting the tube
• D. Elevate the head of the bed 60 to 90 degrees

Correct answer: D

Rationale: Elevating the head of the bed 60 to 90 degrees is the correct intervention to facilitate proper placement of the NG tube. This position helps to use gravity to guide the tube smoothly into the gastrointestinal tract. Soaking the NG tube in warm water (Choice A) is not necessary for proper placement. Inserting the tube with the client's head tilted back (Choice B) can cause discomfort and may lead to improper placement. Applying suction while inserting the tube (Choice C) is not recommended as it can cause trauma to the nasal passages and esophagus.

3. To assess the quality of an adult client’s pain, what approach should the nurse use?

• A. Ask the client to rate the pain on a scale of 1 to 10.
• B. Ask the client to describe the pain.
• C. Observe the client’s nonverbal cues.
• D. Determine the client’s pain tolerance.

Correct answer: B

Rationale: The correct approach for assessing the quality of an adult client's pain is to ask the client to describe the pain. By doing so, the nurse gains valuable information about the quality, location, and nature of the pain directly from the client. This approach allows for a more comprehensive understanding of the pain experience. Choice A, asking the client to rate the pain on a scale of 1 to 10, focuses more on intensity rather than quality. Choice C, observing the client's nonverbal cues, can provide additional information but may not fully capture the client's subjective experience of pain. Choice D, determining the client's pain tolerance, is not directly related to assessing the quality of pain but rather to how much pain a client can endure.

4. When is the best time to administer pancreatic enzyme replacement?

• A. Before meals and snacks
• B. Before bedtime
• C. Early in the morning
• D. After meals and snacks

Correct answer: A

Rationale: The correct answer is to administer pancreatic enzyme replacement before meals and snacks. This timing is crucial as it allows the enzymes to assist in the digestion of carbohydrates, fats, and proteins that are consumed during the meals. Administering the replacement after meals and snacks would not be effective as the enzymes need to be present in the digestive system when food is consumed. Options B and C are incorrect as they do not align with the optimal timing for pancreatic enzyme replacement administration.

5. The nurse is caring for a client with a nasogastric tube. Which action should the nurse take to ensure proper functioning of the tube?

• A. Flush the tube with 50 mL of normal saline every 8 hours
• B. Clamp the tube when not in use
• C. Position the client in a supine position
• D. Verify tube placement by checking pH of gastric contents

Correct answer: D

Rationale: Verifying tube placement by checking the pH of gastric contents is crucial to ensure the nasogastric tube is correctly positioned in the stomach. This action helps prevent complications such as aspiration. Flushing the tube with normal saline every 8 hours is not necessary for ensuring proper functioning of the tube. Clamping the tube when not in use may lead to the build-up of gastric secretions and blockages. Positioning the client in a supine position is not directly related to ensuring the proper functioning of the nasogastric tube.

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