Nursing Elites

1. A nurse is caring for a client who has anemia and a hemoglobin level of 8 g/dL. Which of the following findings should the nurse expect?

• A. Jaundice.
• B. Bradycardia.
• C. Tachypnea.
• D. Hypertension.

Correct answer: C

Rationale: The correct answer is C: Tachypnea. Anemia leads to decreased oxygen-carrying capacity due to low hemoglobin levels, prompting the body to increase respiratory rate to enhance oxygen uptake. Jaundice (choice A) is associated with liver issues, not anemia. Bradycardia (choice B) and Hypertension (choice D) are not typically expected findings in clients with anemia; instead, tachycardia may occur as the body compensates for the decreased oxygen delivery.

2. A healthcare professional is reviewing the laboratory findings of a client who has diabetes mellitus. Which of the following findings indicates a need to revise the client's plan of care?

• A. Serum sodium 144 mEq/L.
• B. HbA1c 10%.
• C. Random serum glucose 190 mg/dL.
• D. Creatinine 1.2 mg/dL.

Correct answer: C

Rationale: Elevated random serum glucose levels of 190 mg/dL indicate hyperglycemia and poor blood sugar control, requiring a revised plan of care. HbA1c levels above 7% also indicate long-term poor control of blood sugar. Serum sodium of 144 mEq/L and creatinine of 1.2 mg/dL are within normal ranges and do not directly indicate a need for a plan of care revision.

3. A nurse is caring for a client who has depression and reports taking St. John's Wort along with citalopram. The nurse should monitor the client for which condition as a result of an interaction between these substances?

• A. Tardive dyskinesia.
• B. Serotonin syndrome.
• C. Pseudoparkinsonism.
• D. Acute dystonia.

Correct answer: B

Rationale: The correct answer is B: Serotonin syndrome. Serotonin syndrome can occur due to the interaction between citalopram, an SSRI, and St. John's Wort, an herbal supplement. Symptoms of serotonin syndrome include confusion, agitation, rapid heart rate, high blood pressure, dilated pupils, loss of muscle coordination, and sweating. Choices A, C, and D are incorrect as they are not typically associated with the interaction between citalopram and St. John's Wort. Tardive dyskinesia is a movement disorder associated with long-term use of certain medications, pseudoparkinsonism is a side effect of certain antipsychotic medications, and acute dystonia is a movement disorder caused by certain medications like antipsychotics.

4. A nurse is providing teaching to a client who has diabetes mellitus and a new prescription for insulin glargine. Which of the following instructions should the nurse include?

• A. You should inject this medication once a day, at the same time each day.
• B. You should expect your blood glucose level to increase immediately after administration.
• C. You should rotate injection sites between your abdomen and thigh.
• D. You should inject this medication with your meals.

Correct answer: A

Rationale: The correct instruction that the nurse should include is to inject insulin glargine once a day, at the same time each day. Insulin glargine is a long-acting insulin that provides a consistent level of insulin over 24 hours, helping to maintain stable blood glucose levels. Option B is incorrect because insulin glargine does not cause an immediate increase in blood glucose levels. Option C is important for preventing lipodystrophy but is not specific to insulin glargine administration. Option D is incorrect because insulin glargine is typically administered at the same time each day, regardless of meals.

5. A nurse is caring for a client who is 1 day postoperative following a below-the-knee amputation. Which of the following actions should the nurse take?

• A. Keep the residual limb flat on the bed
• B. Elevate the residual limb on a pillow
• C. Place the client in a prone position for 30 minutes 4 times a day
• D. Keep the residual limb dependent

Correct answer: C

Rationale: The correct action the nurse should take is to place the client in a prone position for 30 minutes four times a day. This position helps prevent contractures after an amputation by stretching the hip flexors and preventing shortening of the residual limb. Keeping the residual limb flat on the bed (Choice A) may lead to contractures. Elevating the residual limb on a pillow (Choice B) can also cause contractures and hinder proper healing. Keeping the residual limb dependent (Choice D) is not recommended as it does not promote proper positioning and circulation.

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