Nursing Elites

1. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patient’s provider to discuss an order for

• A. a low-potassium diet.
• B. intravenous sodium bicarbonate.
• C. Kayexalate and sorbitol.
• D. salt substitutes.

Correct answer: A

Rationale: In the scenario presented, the patient is experiencing mild hyperkalemia with a potassium level of 5.4 mEq/L. The appropriate intervention for mild hyperkalemia is a low-potassium diet to restrict potassium intake. This helps in managing and preventing further elevation of potassium levels. Intravenous sodium bicarbonate is not indicated as the patient's sodium level is normal at 140 mEq/L. Kayexalate, a cation-exchange resin, is typically used for severe hyperkalemia to promote potassium excretion. Salt substitutes, which often contain potassium chloride, should be avoided in patients with hyperkalemia as they can exacerbate the condition by increasing potassium levels further.

2. The patient is receiving a high dose of tetracycline (Sumycin). Which laboratory values should the nurse monitor while caring for this patient?

• A. Blood urea nitrogen (BUN) and creatinine levels
• B. Complete blood counts
• C. Electrolytes
• D. Liver enzyme levels

Correct answer: A

Rationale: High doses of tetracyclines can lead to nephrotoxicity, especially when given along with other nephrotoxic drugs. Renal function tests, such as monitoring blood urea nitrogen (BUN) and creatinine levels, should be performed to assess for nephrotoxicity. Monitoring complete blood counts (choice B) is not directly related to tetracycline therapy. Checking electrolytes (choice C) is important but not the priority when monitoring for tetracycline-induced nephrotoxicity. Monitoring liver enzyme levels (choice D) is not typically indicated in the context of tetracycline therapy.

3. What is the most common cause of peptic ulcers?

• A. Helicobacter pylori infection
• B. NSAID use
• C. Excessive alcohol consumption
• D. Stress

Correct answer: A

Rationale: Helicobacter pylori infection is the most common cause of peptic ulcers. This bacterium can weaken the protective mucous coating of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath. NSAID use (Choice B) can also cause peptic ulcers by disrupting the stomach's mucosal barrier. Excessive alcohol consumption (Choice C) and stress (Choice D) can exacerbate and contribute to ulcer formation but are not the primary cause.

4. A male client expresses concern about how a hypophysectomy will affect his sexual function. Which of the following statements provides the most accurate information about the physiologic effects of hypophysectomy?

• A. Removing the source of excess hormone should restore the client's libido, erectile function, and fertility.
• B. Potency will be restored, but the client will remain infertile.
• C. Fertility will be restored, but impotence and decreased libido will persist.
• D. Exogenous hormones will be needed to restore erectile function after the adenoma is removed.

Correct answer: A

Rationale: Choice A is the most accurate statement regarding the physiologic effects of hypophysectomy on sexual function. The client's sexual problems are directly related to excessive hormone levels. Removing the source of excess hormone secretion through hypophysectomy should allow the client to return to a normal physiologic pattern, which includes restoring libido, erectile function, and fertility. Choices B, C, and D are incorrect. Choice B incorrectly states that the client will remain infertile, which is not necessarily true after a hypophysectomy. Choice C inaccurately suggests that fertility will be restored while impotence and decreased libido will persist, which is not aligned with the expected outcomes of hypophysectomy. Choice D is incorrect because exogenous hormones are typically not needed to restore erectile function after the adenoma is removed; rather, the removal of the source of excessive hormone secretion should address the sexual function concerns.

5. A client with a chest tube attached to a closed drainage system has undergone a chest x-ray, which revealed that the affected lung is fully reexpanded. The nurse anticipates that the next assessment of the chest tube system will reveal:

• A. No fluctuation in the water seal chamber
• B. Continuous bubbling in the water seal chamber
• C. Increased drainage in the collection chamber
• D. Continuous gentle suction in the suction control chamber

Correct answer: A

Rationale: When the client's lung is fully reexpanded, the chest tube drainage system will no longer be actively draining, and there will be no fluctuation in the water seal chamber. Option B, continuous bubbling in the water seal chamber, indicates an air leak in the system, which is not expected when the lung is fully expanded. Option C, increased drainage in the collection chamber, would not be expected when the lung is reexpanded as there should be minimal to no drainage. Option D, continuous gentle suction in the suction control chamber, would not be appropriate when the lung is fully reexpanded and the chest tube is typically on a water seal system at this point to promote reexpansion and prevent air from entering the pleural space.

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