Nursing Elites

1. The client has just been diagnosed with Addison's disease. Which clinical manifestation should the nurse expect to find?

• A. Hypertension and hyperglycemia.
• B. Hyperpigmentation and hypotension.
• C. Exophthalmos and tachycardia.
• D. Weight gain and fluid retention.

Correct answer: B

Rationale: Hyperpigmentation and hypotension are classic clinical manifestations of Addison's disease due to decreased cortisol production. Hyperpigmentation occurs due to elevated levels of ACTH, leading to increased melanin synthesis. Hypotension results from aldosterone deficiency, causing sodium loss and volume depletion.

2. A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

3. A client with cirrhosis is at risk for bleeding. Which laboratory test is most important to monitor?

• A. Blood glucose
• B. Serum creatinine
• C. Prothrombin time (PT)
• D. Electrolytes

Correct answer: C

Rationale: In clients with cirrhosis, monitoring the Prothrombin time (PT) is crucial as it assesses the blood's ability to clot. Cirrhosis can lead to impaired liver function, affecting the synthesis of clotting factors, hence increasing the risk of bleeding. Maintaining a close watch on PT levels helps in timely intervention to prevent excessive bleeding episodes. Blood glucose (Choice A) is not directly related to the clotting function; serum creatinine (Choice B) and electrolytes (Choice D) are important, but in cirrhosis, monitoring PT takes precedence due to the increased bleeding risk.

4. A client with newly diagnosed diabetes mellitus is being discharged home. Which statement indicates the client understands the instructions about managing blood glucose levels?

• A. I will test my blood glucose level once a week.
• B. I should eat a snack if my blood glucose is 70 mg/dl.
• C. If I feel shaky, I should take another dose of insulin.
• D. It's okay to skip a meal if I'm not hungry.

Correct answer: B

Rationale: Choice B is the correct answer. Eating a snack when blood glucose is low (70 mg/dl) can help prevent hypoglycemia. It is important for clients with diabetes to manage their blood glucose levels to prevent complications, and consuming a snack when glucose levels drop can help maintain the balance.

5. While assessing a client with preeclampsia who is receiving magnesium sulfate, the nurse notes her deep tendon reflexes are 1+, respiratory rate is 12 breaths/minute, urinary output is 90 ml in 4 hours, and magnesium sulfate level is 9 mg/dl. What intervention should the nurse implement based on these findings?

• A. Continue the magnesium sulfate infusion as prescribed.
• B. Decrease the magnesium sulfate infusion by one-half.
• C. Stop the magnesium sulfate infusion immediately.
• D. Administer calcium gluconate immediately.

Correct answer: C

Rationale: The nurse should stop the magnesium sulfate infusion immediately in a client with preeclampsia exhibiting diminished reflexes, respiratory depression, and low urinary output, which indicate magnesium sulfate toxicity. This action is crucial to prevent further complications and adverse effects on the client.

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