Nursing Elites

1. A female client taking a liquid iron preparation expresses concern that her tooth color has darkened since starting the medication. What action should the PN implement?

• A. Teach the client to use a straw when taking the medication to reduce further tooth staining
• B. Advise the client to withhold further doses until consulting with the healthcare provider
• C. Reassure the client that this change indicates the medication is having the desired effect
• D. Determine if the client is also experiencing mouth or gum pain and difficulty swallowing

Correct answer: A

Rationale: The correct action for the PN to implement is to teach the client to use a straw when taking the medication to reduce further tooth staining. Using a straw minimizes contact between the iron preparation and the teeth, helping prevent additional staining. Choice B is incorrect because withholding doses without consulting the healthcare provider could be detrimental to the client's health. Choice C is incorrect because darkening of tooth color is not an expected effect of liquid iron preparation and should not be reassured as a desired effect. Choice D is incorrect as it does not directly address the client's concern about tooth staining.

2. What is the primary function of surfactant in the lungs?

• A. Reduce surface tension
• B. Enhance oxygen absorption
• C. Facilitate carbon dioxide release
• D. Increase lung volume

Correct answer: A

Rationale: The primary function of surfactant in the lungs is to reduce surface tension in the alveoli. This reduction in surface tension prevents lung collapse and allows for easier breathing. It is particularly crucial in premature infants to help with lung expansion. Choice B is incorrect because surfactant primarily affects surface tension, not oxygen absorption. Choice C is incorrect because surfactant's main role is not in facilitating carbon dioxide release. Choice D is incorrect because surfactant does not directly increase lung volume; its main role is in reducing surface tension.

3. Which of the following is the best method for confirming nasogastric tube placement?

• A. Auscultating over the stomach while injecting air
• B. Checking the pH of the aspirate
• C. Observing the patient’s response during feeding
• D. Measuring the external length of the tube

Correct answer: B

Rationale: Checking the pH of the aspirate is the most reliable method to confirm nasogastric tube placement as it provides direct evidence of the tube's location in the stomach. When the pH is acidic (pH < 5), it indicates that the tube is correctly placed in the stomach. Auscultating over the stomach while injecting air may not always be accurate, as the sound can be misleading due to various factors. Observing the patient’s response during feeding is not a definitive method for confirming tube placement, as it can be influenced by other factors. Measuring the external length of the tube does not ensure correct placement within the GI tract and can be affected by external factors like patient anatomy.

4. A female client who has been taking oral contraceptives for the past year comes to the clinic for an annual exam. Which finding is most important for the PN to report to the HCP?

• A. Breast tenderness
• B. Change in menstrual flow
• C. Left calf pain
• D. Weight gain of 5 pounds

Correct answer: C

Rationale: Left calf pain could indicate deep vein thrombosis (DVT), a serious side effect of oral contraceptives. Reporting this finding to the healthcare provider is critical for further evaluation and treatment. Breast tenderness and change in menstrual flow are common side effects of oral contraceptives and may not be as urgent as left calf pain. Weight gain of 5 pounds, while noteworthy, is not as concerning as a possible indication of DVT.

5. The PN identifies an electrolyte imbalance, exhibited by changes in mental status, and an elevated blood pressure for a client with progressive heart disease. Which intervention should the PN implement first?

• A. Record usual eating patterns
• B. Evaluate for muscle cramping
• C. Document abdominal girth
• D. Elevate both legs on pillows

Correct answer: B

Rationale: Evaluating for muscle cramping, which is a sign of electrolyte imbalance, is crucial in this scenario. Electrolyte imbalances, especially involving potassium or calcium, can lead to serious complications such as arrhythmias or seizures, which need immediate attention. Recording eating patterns (choice A) may be important for overall assessment but is not the priority in this situation. Documenting abdominal girth (choice C) and elevating legs on pillows (choice D) are not directly related to addressing the immediate concern of electrolyte imbalance and its potential complications.

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