Nursing Elites

1. The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotensin-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)?

• A. A complete blood count
• B. BUN and creatinine
• C. Electrolytes
• D. Glucose

Correct answer: C

Rationale: The correct answer is 'C. Electrolytes.' When trimethoprim-sulfamethoxazole (TMP-SMX) is taken with an ACE inhibitor, there is an increased risk of hyperkalemia due to the combined effects on potassium levels. Monitoring electrolytes, specifically potassium, is essential to detect and manage this potential drug interaction. Choices A, B, and D are incorrect because while they are important tests in general patient care, they are not specifically indicated to monitor for the drug interaction between TMP-SMX and ACE inhibitors.

2. A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which pathophysiological process supports the client's respiratory acidosis?

• A. Carbon dioxide is converted in the kidneys for elimination.
• B. Blood oxygen levels are stimulating the respiratory rate.
• C. Hyperventilation is eliminating carbon dioxide rapidly.
• D. High levels of carbon dioxide have accumulated in the blood.

Correct answer: D

Rationale: The correct answer is D. High levels of carbon dioxide in the blood are indicative of respiratory acidosis, often due to inadequate ventilation. In respiratory acidosis, there is retention of carbon dioxide (hypercapnia) leading to an increase in carbonic acid levels in the blood, resulting in an acidic pH. Option A is incorrect because carbon dioxide elimination primarily occurs through the lungs, not the kidneys. Option B is incorrect because blood oxygen levels primarily affect the respiratory rate to regulate oxygen levels, not carbon dioxide levels. Option C is incorrect because hyperventilation would lead to a decrease, not an increase, in carbon dioxide levels.

3. The client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

• A. 11 AM, shortly before lunch.
• B. 1 PM, shortly after lunch.
• C. 6 PM, shortly after dinner.
• D. 1 AM, while sleeping.

Correct answer: D

Rationale: The correct answer is D, 1 AM, while sleeping. Isophane insulin suspension NPH (Humulin N) peaks around 6-8 hours after administration, which increases the risk of hypoglycemia during the night. Choice A, 11 AM, shortly before lunch, is incorrect because the peak effect of NPH insulin occurs much later. Choice B, 1 PM, shortly after lunch, is incorrect as it is too early for the peak effect of NPH insulin. Choice C, 6 PM, shortly after dinner, is also incorrect because the peak risk of hypoglycemia with NPH insulin occurs later in the night.

4. In a patient with cirrhosis, which of the following lab results is most concerning?

• A. Elevated liver enzymes.
• B. Low albumin levels.
• C. Elevated bilirubin levels.
• D. Low platelet count.

Correct answer: D

Rationale: In a patient with cirrhosis, a low platelet count is the most concerning lab result. Thrombocytopenia, or low platelet count, is common in cirrhosis due to impaired platelet production in the liver. It significantly increases the risk of bleeding and can lead to serious complications such as hemorrhage. Elevated liver enzymes (Choice A) are expected in cirrhosis but may not directly indicate the severity of the disease. Low albumin levels (Choice B) are common in cirrhosis and can contribute to fluid retention but do not pose an immediate risk of bleeding. Elevated bilirubin levels (Choice C) are also expected in cirrhosis and typically indicate impaired liver function but do not directly increase the risk of bleeding as much as a low platelet count.

5. The client with chronic renal failure is being taught about the importance of fluid restrictions. Which of the following statements by the client indicates that the teaching has been effective?

• A. I can drink as much fluid as I want, as long as I take my medication.
• B. I will need to limit my fluid intake to prevent fluid overload.
• C. I can drink as much water as I want, as long as I limit other fluids.
• D. I will need to drink only when I am thirsty.

Correct answer: B

Rationale: The correct answer is B: 'I will need to limit my fluid intake to prevent fluid overload.' In chronic renal failure, fluid restrictions are crucial to prevent fluid overload and further damage to the kidneys. Option A is incorrect as unrestricted fluid intake can worsen the condition. Option C is also incorrect as total fluid intake needs to be restricted, not just other fluids. Option D is not ideal because thirst may not accurately reflect the body's fluid needs in chronic renal failure.

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