Nursing Elites

1. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?

• A. Elevated serum calcium
• B. Low serum parathyroid hormone (PTH)
• C. Elevated serum vitamin D
• D. Low urine calcium

Correct answer: A

Rationale: In primary hyperparathyroidism, there is excess secretion of parathyroid hormone (PTH) leading to increased resorption of calcium from bones and decreased excretion of calcium by the kidneys. This results in elevated serum calcium levels. Elevated serum calcium is a hallmark characteristic of primary hyperparathyroidism, making it the correct answer. Low serum parathyroid hormone (PTH) (Choice B) is incorrect because primary hyperparathyroidism is associated with elevated PTH levels due to the malfunction of the parathyroid glands. Elevated serum vitamin D (Choice C) is incorrect because primary hyperparathyroidism is not typically associated with elevated vitamin D levels. Low urine calcium (Choice D) is incorrect as primary hyperparathyroidism leads to decreased calcium excretion by the kidneys, resulting in high levels of calcium in the urine.

2. Why should a 30-year-old Caucasian woman who works the night shift take Vitamin D supplements?

• A. It's a standard part of the overall nutritional treatment for the prevention of osteomalacia.
• B. It helps your intestines absorb calcium, which is important for bone formation.
• C. It stimulates skin cells to produce calcium, which is then released into the bloodstream to be used for bone formation.
• D. Vitamin D supplements should not be taken by someone of your age.

Correct answer: B

Rationale: The correct answer is B: 'It helps your intestines absorb calcium, which is important for bone formation.' Vitamin D plays a crucial role in aiding the absorption of calcium from the intestines into the bloodstream, which is essential for bone health and formation. Choice A is incorrect because it does not specifically address the role of Vitamin D in calcium absorption. Choice C is incorrect as Vitamin D does not stimulate skin cells to produce calcium; rather, it helps regulate calcium levels in the body. Choice D is incorrect as age alone is not a contraindication for Vitamin D supplementation; the need for supplementation is based on individual health status and risk factors.

3. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following?

• A. Observe for neurological changes
• B. Monitor for any signs of renal failure
• C. Check the food diary
• D. Observe for signs of bleeding

Correct answer: D

Rationale: The priority concern for a client receiving thrombolytic medication, such as tissue plasminogen activator (alteplase), is to monitor for signs of bleeding. Thrombolytics work by converting plasminogen to plasmin, which degrades fibrin. This process can lead to the breakdown of both fibrin-bound plasminogen on thrombi surfaces and unbound plasminogen in the plasma. The resulting plasmin can degrade fibrin, fibrinogen, factor V, and factor VIII. Observing for signs of bleeding is crucial due to the increased risk of hemorrhage associated with thrombolytic therapy. Monitoring for neurological changes, signs of renal failure, or checking the food diary are not the immediate priorities compared to detecting and managing potential bleeding complications.

4. The nurse is reviewing the characteristics of culture. Which statement is correct regarding the development of one's culture?

• A. Learned through language acquisition and socialization.
• B. Genetically determined on the basis of racial background.
• C. A nonspecific phenomenon and is adaptive but unnecessary.
• D. Biologically determined on the basis of physical characteristics.

Correct answer: A

Rationale: Culture is a complex phenomenon that includes attitudes, beliefs, self-definitions, norms, roles, and values learned from birth through the processes of language acquisition and socialization. It is not biologically or genetically determined, but rather acquired through social interactions. The correct answer, 'Learned through language acquisition and socialization,' aligns with the understanding that culture is a learned behavior. Choices B, C, and D are incorrect because culture is not genetically determined, nonspecific, or biologically based on physical characteristics. Understanding that culture is acquired through language and socialization is essential for healthcare providers to provide culturally competent care.

5. A client is brought into the emergency room where the physician suspects that he has cardiac tamponade. Based on this diagnosis, the nurse would expect to see which of the following signs or symptoms in this client?

• A. Fever, fatigue, malaise
• B. Hypotension and distended neck veins
• C. Cough and hemoptysis
• D. Numbness and tingling in the extremities

Correct answer: B

Rationale: Cardiac tamponade occurs when fluid or blood accumulates in the pericardium, preventing the heart from contracting properly. This leads to decreased cardiac output and is considered a medical emergency. Classic signs of cardiac tamponade include hypotension (low blood pressure) and distended neck veins due to the increased pressure around the heart. These signs result from the compromised ability of the heart to pump effectively. Choices A, C, and D are not typically associated with cardiac tamponade. Fever, fatigue, and malaise are non-specific symptoms that can be seen in various conditions. Cough and hemoptysis are more commonly associated with respiratory conditions, while numbness and tingling in the extremities are neurological symptoms not typically seen in cardiac tamponade.

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