Nursing Elites

1. A healthcare professional is reviewing laboratory results for a client who has cirrhosis. Which of the following findings should the professional report to the provider?

• A. Albumin 3.5 g/dL
• B. Bilirubin 1.0 mg/dL
• C. INR 3.0
• D. Ammonia 80 mcg/dL

Correct answer: C

Rationale: An INR of 3.0 is elevated, indicating impaired blood clotting function, which poses a significant risk of bleeding in clients with cirrhosis. This finding should be promptly reported to the provider for further evaluation and management. Choice A (Albumin 3.5 g/dL) is within the normal range and indicates adequate liver synthetic function, so it does not require immediate reporting. Choice B (Bilirubin 1.0 mg/dL) is also within the normal range and typically seen in clients without significant liver dysfunction, so it does not need urgent attention. Choice D (Ammonia 80 mcg/dL) is elevated, but it is not the priority finding in cirrhosis; elevated ammonia levels are associated with hepatic encephalopathy rather than increased bleeding risk.

2. A nurse overhears two assistive personnel (AP) discussing a client in an elevator. What action should the nurse take?

• A. Contact the client's family about the incident.
• B. Notify the client's provider about the incident.
• C. File a complaint with the facility's ethics committee.
• D. Report the incident to the AP's charge nurse.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to report the incident to the AP's charge nurse. This is important because discussing a client's information violates confidentiality policies. Contacting the client's family (Choice A) is not appropriate as it may breach confidentiality further. Notifying the client's provider (Choice B) is not the initial action to take in this situation, as addressing it within the facility should come first. Filing a complaint with the facility's ethics committee (Choice C) is not the immediate step and might not directly address the issue at hand.

3. How should a healthcare professional handle a patient who is refusing to take a prescribed medication?

• A. Immediately give the medication
• B. Assess the reasons for refusal
• C. Document refusal
• D. Explore alternative treatment options

Correct answer: B

Rationale: Assessing the reasons for refusal is crucial as it allows the healthcare professional to understand the patient's concerns, which can range from fear of side effects to cost issues. By identifying the underlying reasons, the healthcare professional can tailor their approach to address these specific concerns, potentially improving medication adherence. Giving the medication immediately (Choice A) without understanding the patient's reasons for refusal can lead to further non-compliance. While documenting refusal (Choice C) is important for legal and tracking purposes, it does not directly address the patient's concerns. Exploring alternative treatment options (Choice D) may be considered after understanding the reasons for refusal, but it is not the initial step in managing medication refusal.

4. 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.

5. A healthcare professional is caring for a client who has a new prescription for metformin. Which of the following laboratory results should the healthcare professional review before administering the medication?

• A. Potassium
• B. Serum creatinine
• C. Sodium
• D. Hemoglobin A1C

Correct answer: B

Rationale: Correct Answer: The healthcare professional should review serum creatinine levels before administering metformin to assess kidney function. Metformin is excreted by the kidneys, and checking serum creatinine helps prevent lactic acidosis, a potential side effect in individuals with impaired renal function. Choice A: Potassium levels are not directly related to the administration of metformin. While monitoring potassium levels is important for some medications, it is not the priority when initiating metformin. Choice C: Sodium levels are not typically assessed specifically before starting metformin. It is not a routine lab test required prior to metformin administration. Choice D: Hemoglobin A1C reflects long-term blood sugar control and is not a lab test that needs to be reviewed before initiating metformin. It is used to monitor diabetes management over time, not for immediate medication administration considerations.

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