Nursing Elites

1. A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Select one that doesn't apply.

• A. Urine specific gravity of 1.040.
• B. Urine output of 350 ml in 24 hours.
• C. Brown ("tea-colored"?) urine.
• D. Generalized edema.

Correct answer: D

Rationale: The correct answer is 'Generalized edema.' Acute glomerulonephritis typically presents with periorbital edema, not generalized edema. Findings in acute glomerulonephritis include dark, smoky, or tea-colored urine (hematuria) due to red blood cells in the urine, elevated blood pressure, and proteinuria. The urine specific gravity may be high due to decreased urine output, but a urine output of 350 ml in 24 hours is extremely low and suggestive of renal impairment. Generalized edema is more commonly associated with nephrotic syndrome, where there is significant proteinuria leading to hypoalbuminemia and subsequent fluid retention in tissues. In acute glomerulonephritis, the edema is usually limited to the face and lower extremities, not generalized.

2. A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over the last two weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?

• A. CBC (Complete Blood Count)
• B. ECG (Electrocardiogram)
• C. Thyroid Function Tests
• D. CT Scan

Correct answer: D

Rationale: A CT scan is most likely to be performed in this scenario. A CT scan would be done to further investigate the cause of the left hemiparesis. Noncontrast CT scanning is commonly used in the acute evaluation of patients with suspected acute stroke to assess for ischemic changes or hemorrhage in the brain. While a CBC may provide information on blood cell counts and general health status, it is not the primary test for evaluating hemiparesis. An ECG is used to assess heart function and rhythm, which is not the main concern in this case. Thyroid function tests evaluate thyroid hormone levels and are not typically the initial tests for evaluating hemiparesis and confusion.

3. You are caring for Thomas N., a 77-year-old man with edema in his legs and a fluid restriction. You have been assigned to weigh him daily. Based on these symptoms and the care he is receiving, what disorder is he most likely affected by?

• A. Diabetes
• B. Dementia
• C. Congestive heart failure
• D. Contiguous heart disease

Correct answer: C

Rationale: Thomas N.'s symptoms of edema in his legs and fluid restriction point towards congestive heart failure (CHF) rather than dementia or diabetes. In CHF, patients often present with dependent edema in their legs due to excessive blood volume, leading to fluid intake restrictions and a low-salt diet. Daily weight monitoring is crucial in CHF to assess fluid retention or loss. Diabetes primarily affects blood sugar levels, dementia is a cognitive disorder, and 'Contiguous heart disease' is not a recognized medical term, making choices A, B, and D incorrect in this scenario.

4. Which laboratory test result should the nurse monitor to evaluate the effects of therapy for a 62-year-old female patient with acute pancreatitis?

• A. Calcium
• B. Bilirubin
• C. Amylase
• D. Potassium

Correct answer: C

Rationale: The correct answer is C: Amylase. In acute pancreatitis, amylase levels are typically elevated. Monitoring amylase levels helps assess the effectiveness of therapy in managing the condition. Elevated amylase is a key indicator of pancreatic inflammation. Calcium (Choice A) levels may be affected in pancreatitis, but they are not the primary indicator for evaluating therapy effectiveness. Bilirubin (Choice B) and Potassium (Choice D) levels may also be altered in pancreatitis, but they are not specific markers for monitoring therapy response in acute pancreatitis.

5. A healthcare provider is assessing vital signs in pediatric patients. Which of the following vital signs is abnormal?

• A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg
• B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg
• C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg
• D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg

Correct answer: B

Rationale: The normal range of vital signs for pediatric patients varies with age. For 11 to 14-year-olds, the normal vital sign ranges are: Heart rate: 60-105 BPM; Respiratory rate: 12-20 RPM; Blood pressure: Systolic 85-120 mmHg, Diastolic 55-80 mmHg. The 13-year-old female in choice B has a diastolic blood pressure below the normal range, indicating hypotension. Additionally, her heart rate is at the upper limit of normal, and her respiratory rate is within normal limits. Choices A, C, and D all fall within the normal ranges for vital signs in pediatric patients.

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