Nursing Elites

1. A client who is at 28 weeks of gestation is being taught by a nurse about managing heartburn. Which of the following instructions should the nurse include?

• A. Eat small, frequent meals.
• B. Drink a glass of milk with each meal.
• C. Lie down after meals.
• D. Drink plenty of fluids with meals.

Correct answer: A

Rationale: The correct instruction for managing heartburn during pregnancy is to eat small, frequent meals. This helps prevent heartburn by reducing gastric distention. Option B, drinking a glass of milk with each meal, may exacerbate heartburn in some individuals due to its fat content. Option C, lying down after meals, can worsen heartburn as it allows stomach acid to flow back into the esophagus. Option D, drinking plenty of fluids with meals, can also contribute to heartburn by distending the stomach. Therefore, the best advice for managing heartburn during pregnancy is to eat small, frequent meals.

2. A nurse is reviewing the laboratory results for a client who has Cushing's disease. The nurse should expect the client to have an increase in which of the following laboratory values?

• A. Serum glucose level.
• B. Serum calcium level.
• C. Lymphocyte count.
• D. Serum potassium level.

Correct answer: A

Rationale: The correct answer is A: Serum glucose level. In Cushing's disease, elevated cortisol levels lead to increased gluconeogenesis, insulin resistance, and breakdown of proteins and fats, resulting in elevated blood glucose levels. This is known as hyperglycemia. The other options, including serum calcium level (choice B), lymphocyte count (choice C), and serum potassium level (choice D), are not typically affected by Cushing's disease. Therefore, they are incorrect choices.

3. A nurse is reviewing the medical record of a client who has acute kidney injury. Which of the following findings should the nurse report to the provider?

• A. Blood urea nitrogen (BUN) 15 mg/dL
• B. Urine output of 45 mL/hr
• C. Serum creatinine 3.5 mg/dL
• D. Calcium 9 mg/dL

Correct answer: C

Rationale: The correct answer is C, 'Serum creatinine 3.5 mg/dL.' An elevated serum creatinine level indicates worsening kidney function and impaired renal clearance, which should be reported to the provider promptly. Choice A, 'Blood urea nitrogen (BUN) 15 mg/dL,' is within the normal range (7-20 mg/dL) and does not indicate acute kidney injury. Choice B, 'Urine output of 45 mL/hr,' is a low urine output but does not directly reflect kidney function decline. Choice D, 'Calcium 9 mg/dL,' is within the normal calcium range (8.5-10.5 mg/dL) and is not specifically indicative of acute kidney injury.

4. A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis (DKA). Which of the following findings should the nurse report to the provider?

• A. Potassium 4.2 mEq/L
• B. Glucose 250 mg/dL
• C. Bicarbonate 20 mEq/L
• D. Sodium 135 mEq/L

Correct answer: B

Rationale: The correct answer is B. A glucose level of 250 mg/dL indicates hyperglycemia, which is expected in DKA. However, in the context of DKA management, persistent or worsening hyperglycemia can indicate inadequate treatment response or complications, necessitating further monitoring and intervention. Potassium levels are crucial in DKA due to the risk of hypokalemia, but a level of 4.2 mEq/L is within the normal range. Bicarbonate levels are typically low in DKA, making a value of 20 mEq/L consistent with the condition. Sodium levels of 135 mEq/L are also within normal limits and not a priority for immediate reporting in the context of DKA.

5. A nurse is planning care for a client who is 1 day postoperative following a hypophysectomy for the removal of a pituitary tumor. Which of the following findings requires further assessment by the nurse?

• A. Glasgow Coma Scale score of 15
• B. Blood drainage on the initial dressing measuring 3 cm
• C. Report of dry mouth
• D. Urinary output greater than fluid intake

Correct answer: D

Rationale: The correct answer is D. Urinary output greater than fluid intake could indicate diabetes insipidus, a complication following hypophysectomy. Diabetes insipidus is characterized by excessive urination and extreme thirst due to inadequate levels of antidiuretic hormone (ADH). Options A, B, and C are all expected findings in the immediate postoperative period following a hypophysectomy. A Glasgow Coma Scale score of 15 indicates the highest level of consciousness, blood drainage on the initial dressing is a common finding after surgery, and dry mouth can be a side effect of anesthesia and surgical procedures.

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