Nursing Elites

1. In a patient with chronic kidney disease, which of the following is a common electrolyte imbalance?

• A. Hyperkalemia.
• B. Hypokalemia.
• C. Hypernatremia.
• D. Hyponatremia.

Correct answer: A

Rationale: Hyperkalemia is a common electrolyte imbalance in chronic kidney disease. In chronic kidney disease, the kidneys' reduced function leads to the decreased excretion of potassium, resulting in elevated serum potassium levels. This can be dangerous as hyperkalemia can lead to life-threatening arrhythmias. Hypokalemia (Choice B) is less common in chronic kidney disease as the impaired kidneys tend to retain potassium. Hypernatremia (Choice C) is more commonly seen in conditions such as dehydration, not primarily in chronic kidney disease. Hyponatremia (Choice D) is also possible in chronic kidney disease but is less common compared to hyperkalemia.

2. Which of the following is an expected finding in a patient with hypothyroidism?

• A. Weight gain.
• B. Weight loss.
• C. Increased appetite.
• D. Diarrhea.

Correct answer: A

Rationale: Weight gain is an expected finding in hypothyroidism due to the decreased metabolic rate. Hypothyroidism leads to a slowing down of bodily functions, including metabolism, which can result in weight gain. Weight loss (Choice B) is more commonly associated with hyperthyroidism where there is an increase in metabolic rate. Increased appetite (Choice C) is also more typical of hyperthyroidism as the body is burning energy at a faster rate. Diarrhea (Choice D) is not a typical symptom of hypothyroidism; instead, constipation is more often observed due to the slowing down of the digestive system.

3. A 32-year-old female client complains of severe abdominal pain each month before her menstrual period, painful intercourse, and painful defecation. Which additional history should the nurse obtain that is consistent with the client's complaints?

• A. Frequent urinary tract infections.
• B. Inability to get pregnant.
• C. Premenstrual syndrome.
• D. Chronic use of laxatives.

Correct answer: B

Rationale: The correct answer is B: 'Inability to get pregnant.' The symptoms described in the client's complaints, which include severe abdominal pain before menstruation, painful intercourse, and painful defecation, are indicative of endometriosis. Endometriosis is a condition characterized by the abnormal presence of endometrial tissue outside the uterus, commonly leading to infertility. While choices A, C, and D may be associated with other conditions, they are not directly related to the symptoms described by the client, making them incorrect choices. Frequent urinary tract infections may suggest a different issue, premenstrual syndrome does not typically present with severe abdominal pain, and chronic use of laxatives is not a typical symptom of endometriosis.

4. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?

• A. A serum drug level greater than the MEC ensures that the drug is bacteriostatic.
• B. A serum drug level greater than the MEC broadens the spectrum of the drug.
• C. A serum drug level greater than the MEC helps eradicate bacterial infections.
• D. A serum drug level greater than the MEC increases the therapeutic index.

Correct answer: C

Rationale: The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Therefore, choice A is incorrect. Broadening the spectrum of a drug refers to its range of activity against different microorganisms, which is not directly related to MEC. Thus, choice B is incorrect. Increasing the therapeutic index involves maximizing the effectiveness of a drug while minimizing its toxicity, which is not specifically related to MEC. Therefore, choice D is also incorrect.

5. A client with chronic heart failure is being taught by a nurse about the importance of daily weights. Which of the following instructions should the nurse include?

• A. Weigh yourself at the same time every day.
• B. Use the same scale for weighing each time.
• C. Record your weight in a journal or log.
• D. Report any weight gain of more than 2 to 3 pounds in a day.

Correct answer: D

Rationale: The correct instruction for a client with chronic heart failure is to report any weight gain of more than 2 to 3 pounds in a day. This weight gain may indicate fluid retention, which is a critical sign of worsening heart failure. Weighing at the same time every day and using the same scale for consistency are good practices, but the crucial action is to promptly report significant weight gain, as stated in option D. Recording the weight in a journal or log can be helpful for tracking trends, but immediate reporting of weight gain is essential for timely intervention in heart failure management. Therefore, option D is the most appropriate instruction for this client.

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