Nursing Elites

1. A nurse is providing teaching to a client who has GERD. Which of the following instructions should the nurse include?

• A. Lie flat for 30 minutes after meals.
• B. Avoid lying down after meals.
• C. Drink hot liquids with meals.
• D. Consume a high-carbohydrate snack at bedtime.

Correct answer: B

Rationale: The correct answer is B: 'Avoid lying down after meals.' This instruction is important for clients with GERD to prevent acid reflux. Lying down after meals can worsen GERD symptoms by allowing stomach acid to flow back into the esophagus. Choices A, C, and D are incorrect. Choice A is incorrect because lying flat after meals can increase the risk of acid reflux. Choice C is incorrect because hot liquids may aggravate GERD symptoms. Choice D is incorrect because consuming a high-carbohydrate snack at bedtime can also trigger acid reflux in individuals with GERD.

2. A nurse is assessing a client who is 1 day postoperative following a bowel resection. Which of the following findings should the nurse report to the provider?

• A. Urine output of 40 mL/hr.
• B. Heart rate of 88/min.
• C. Wound drainage of 25 mL in 24 hours.
• D. Abdominal distention and rigidity.

Correct answer: D

Rationale: Abdominal distention and rigidity may indicate a postoperative complication, such as bowel obstruction or peritonitis, and should be reported to the provider. While monitoring urine output, heart rate, and wound drainage are essential postoperative assessments, they are not as concerning as abdominal distention and rigidity, which could signal a more urgent issue requiring immediate attention.

3. A client with a history of heart failure is receiving furosemide. Which of the following laboratory values should the nurse monitor?

• A. Sodium 140 mEq/L
• B. Calcium 9.0 mg/dL
• C. Potassium 3.2 mEq/L
• D. Chloride 100 mEq/L

Correct answer: C

Rationale: The correct answer is C: Potassium 3.2 mEq/L. A potassium level of 3.2 mEq/L is below the normal range and should be monitored in clients receiving furosemide due to the risk of hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion, leading to hypokalemia. Monitoring potassium levels is crucial to prevent complications such as cardiac arrhythmias. Choices A, B, and D are not directly impacted by furosemide therapy in the same way as potassium levels, making them less relevant for monitoring in this scenario.

4. What is the most critical lab value to monitor for a patient on heparin therapy?

• A. Monitor aPTT levels
• B. Monitor platelet count
• C. Monitor INR levels
• D. Monitor sodium levels

Correct answer: A

Rationale: The correct answer is to monitor aPTT levels. Activated Partial Thromboplastin Time (aPTT) is crucial for assessing the therapeutic effectiveness of heparin, as it reflects the intrinsic pathway of the coagulation cascade. Monitoring aPTT helps ensure that the patient is within the therapeutic range of heparin, minimizing the risk of bleeding complications. Platelet count (choice B) is important to assess for potential heparin-induced thrombocytopenia but is not the primary lab value to monitor during heparin therapy. INR levels (choice C) are monitored in patients on warfarin therapy, not heparin. Sodium levels (choice D) are not directly related to heparin therapy monitoring.

5. A nurse is caring for a client who is receiving chemotherapy. Which of the following findings should the nurse report to the provider?

• A. Alopecia
• B. Weight gain of 1 kg (2.2 lb) in 24 hours
• C. White blood cell count of 6,000/mm³
• D. Temperature of 37.2°C (99°F)

Correct answer: B

Rationale: The correct answer is B. A weight gain of 1 kg (2.2 lb) in 24 hours is concerning as it indicates fluid retention, which can be a sign of complications in clients receiving chemotherapy. Rapid weight gain can be associated with conditions like fluid overload or electrolyte imbalances, which need prompt medical attention. Choices A, C, and D are not typically immediate concerns related to chemotherapy. Alopecia (choice A) is a common side effect of chemotherapy, a white blood cell count of 6,000/mm³ (choice C) falls within the normal range, and a temperature of 37.2°C (99°F) (choice D) is slightly elevated but not a critical finding in this context.

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