Nursing Elites

1. A patient asks the nurse about taking calcium supplements to avoid hypocalcemia. The nurse will suggest that the patient follow which instruction?

• A. Take a calcium and vitamin D combination supplement.
• B. Take calcium along with phosphorus to improve absorption.
• C. Take calcium with antacids to reduce stomach upset.
• D. Use aspirin instead of acetaminophen when taking calcium.

Correct answer: A

Rationale: The correct answer is to take a calcium and vitamin D combination supplement. Vitamin D enhances the absorption of calcium in the body, making it an essential component for calcium utilization. Choice B is incorrect because calcium and phosphorus have an inverse relationship, where an increased level of one mineral decreases the level of the other, so taking them together may not be beneficial. Choice C is incorrect because antacids often contain magnesium, which can promote calcium loss instead of absorption. Choice D is incorrect because aspirin can alter vitamin D levels and interfere with calcium absorption, so it is not recommended when taking calcium supplements.

2. A client in a physician’s office has just made an appointment for an exercise stress test. The client should be instructed to:

• A. Wear sweatpants and a heavy sweatshirt
• B. Eat a small meal just before the procedure
• C. Wear comfortable rubber-soled shoes such as sneakers
• D. Avoid consuming caffeine for 30 minutes before the procedure

Correct answer: C

Rationale: The client should wear comfortable rubber-soled shoes, such as sneakers, for the exercise stress test. This choice ensures safety and stability during the procedure. Wearing sweatpants and a heavy sweatshirt (Choice A) would not be appropriate as the client needs to wear light, loose, comfortable clothing. Eating a small meal just before the procedure (Choice B) could lead to discomfort during the test. Avoiding caffeine for 30 minutes before the procedure (Choice D) is not a specific instruction related to the attire or preparation for the test.

3. A nurse reviews a female client’s laboratory results. Which result from the client’s urinalysis should the nurse recognize as abnormal?

• A. pH 5.6
• B. Ketone bodies present
• C. Specific gravity of 1.020
• D. Clear and yellow color

Correct answer: B

Rationale: The correct answer is B: Ketone bodies present. Ketone bodies in urine indicate abnormal metabolism, specifically the incomplete breakdown of fatty acids. Normally, there should be no ketones present in urine. Ketone bodies are produced when the body uses fat sources instead of glucose for cellular energy. A pH range between 4.6 and 8, a specific gravity between 1.005 and 1.030, and clear yellow color in urine are considered normal findings for a female client’s urinalysis. Therefore, options A, C, and D are within normal ranges and not indicative of abnormal results in the urinalysis.

4. A client has the following arterial blood gas (ABG) results: pH 7.51, PCO2 31 mm Hg, PO2 94 mm Hg, HCO3 24 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: D

Rationale: The ABG results show a pH above the normal range (7.35-7.45) and a decreased PCO2, indicating respiratory alkalosis. In respiratory alkalosis, the pH is increased and the PCO2 is decreased. Metabolic acidosis (choice A) would present with a low pH and low HCO3 levels. Metabolic alkalosis (choice B) would show an increased pH and HCO3 levels. Respiratory acidosis (choice C) would have a low pH and an increased PCO2.

5. The healthcare professional is reviewing a patient’s chart prior to administering gentamicin (Garamycin) and notes that the last serum peak drug level was 9 mcg/mL and the last trough level was 2 mcg/mL. What action will the healthcare professional take?

• A. Administer the next dose as prescribed.
• B. Obtain repeat peak and trough levels before administering the next dose.
• C. Report potential drug toxicity to the patient’s healthcare provider.
• D. Notify the patient’s healthcare provider of decreased drug therapeutic level.

Correct answer: C

Rationale: Gentamicin peak levels should ideally be between 5 to 8 mcg/mL, and trough levels should be within the range of 0.5 to 2 mcg/mL to ensure therapeutic efficacy while minimizing toxicity risk. In this case, the patient's peak level is above the recommended range, and the trough level is at the higher end, indicating potential drug toxicity. Therefore, the correct action for the healthcare professional is to report the possibility of drug toxicity to the patient’s healthcare provider. Administering the next dose as prescribed (Choice A) would exacerbate the toxicity risk. Obtaining repeat peak and trough levels (Choice B) may confirm the current levels but does not address the immediate concern of potential toxicity. Reporting a decreased drug therapeutic level (Choice D) is not the priority in this scenario, as the focus should be on addressing the potential toxicity issue.

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