Nursing Elites

1. Blood is drawn from a client with suspected uric acid calculi for a serum uric acid determination. Which value does the nurse recognize as a normal uric acid level?

• A. 1.7 mg/dL
• B. 5.8 mg/dL
• C. 8.9 mg/dL
• D. 12.8 mg/dL

Correct answer: B

Rationale: The normal range for uric acid is 4.5 to 8 mg/dL for males and 2.5 to 6.2 mg/dL for females. A uric acid level of 5.8 mg/dL falls within the normal range. Choices A, C, and D are outside the normal reference range, making them incorrect. Choice B is the correct answer as it aligns with the typical uric acid levels in the blood.

2. A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. What action should the nurse instruct the patient to perform?

• A. Increase fluid intake.
• B. Take diphenhydramine.
• C. Stop taking TMP-SMX immediately.
• D. Continue taking the medication.

Correct answer: C

Rationale: When a patient develops an all-over rash while taking trimethoprim-sulfamethoxazole (TMP-SMX), it may indicate a serious drug reaction. In this case, the patient should stop taking the medication immediately and notify their healthcare provider. Increasing fluid intake (Choice A) may be beneficial in some cases but is not the priority when a serious drug reaction is suspected. Taking diphenhydramine (Choice B) may help with itching but does not address the underlying issue of a potential drug reaction. Continuing the medication (Choice D) is not advisable when a serious adverse reaction such as a widespread rash occurs.

3. A healthcare professional is reviewing laboratory results for a client who is at risk for nephrotoxicity due to medications. Which of the following serum creatinine results does the healthcare professional document as normal?

• A. 0.2 mg/dL
• B. 1.0 mg/dL
• C. 2.8 mg/dL
• D. 3.9 mg/dL

Correct answer: B

Rationale: The normal serum creatinine level typically ranges from 0.6 to 1.3 mg/dL. A result of 1.0 mg/dL falls within this normal range. A serum creatinine level of 0.2 mg/dL is abnormally low and may indicate decreased muscle mass or malnutrition. On the other hand, results of 2.8 mg/dL and 3.9 mg/dL are elevated, signifying impaired kidney function and potential nephrotoxicity from medications.

4. A nurse is assessing a postoperative client on an hourly basis. The nurse notes that the client’s urine output for the past hour was 25 mL. Based on this finding, the nurse first:

• A. Calls the physician
• B. Increases the rate of the IV infusion
• C. Checks the client’s overall intake and output record
• D. Administers a 250-mL bolus of normal saline solution (0.9%)

Correct answer: C

Rationale: Clients are at risk of hypovolemia postoperatively, and decreased urine output can be an early sign. However, to accurately interpret this finding, the nurse must assess the overall fluid balance by checking the client’s intake and output records. Increasing the IV infusion rate or administering a bolus of normal saline solution without a physician's order would not be appropriate as these interventions require a prescription. The physician should be notified once the nurse has collected all necessary assessment data, including fluid status and vital signs.

5. A client who is receiving chemotherapy asks the nurse, 'Why is so much of my hair falling out each day?' Which response by the nurse best explains the reason for alopecia?

• A. 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.'
• B. 'Alopecia is a common side effect you will experience during long-term steroid therapy.'
• C. 'Your hair will grow back completely after your course of chemotherapy is completed.'
• D. 'The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss.'

Correct answer: A

Rationale: The correct answer is A: 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.' Chemotherapy targets rapidly dividing cells, which include not only cancer cells but also healthy cells like those in hair follicles. This leads to alopecia (hair loss) as a common side effect. Choice B is incorrect as alopecia is primarily associated with chemotherapy and not long-term steroid therapy. Choice C is incorrect because while hair may grow back after chemotherapy, it may not always be to the same extent or thickness. Choice D is incorrect as chemotherapy-induced hair loss is often temporary and reversible, not permanent alterations in hair follicles.

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