Nursing Elites

1. When is the best time to administer pancreatic enzyme replacement?

• A. Before meals and snacks
• B. Before bedtime
• C. Early in the morning
• D. After meals and snacks

Correct answer: A

Rationale: The correct answer is to administer pancreatic enzyme replacement before meals and snacks. This timing is crucial as it allows the enzymes to assist in the digestion of carbohydrates, fats, and proteins that are consumed during the meals. Administering the replacement after meals and snacks would not be effective as the enzymes need to be present in the digestive system when food is consumed. Options B and C are incorrect as they do not align with the optimal timing for pancreatic enzyme replacement administration.

2. A client with partial-thickness burns to the lower extremities is scheduled for whirlpool therapy to debride the burned area. Which intervention should the nurse implement before transporting the client to the physical therapy department?

• A. Apply a sterile dressing to the wound.
• B. Administer an analgesic.
• C. Encourage the client to drink fluids.
• D. Ensure the client's nutritional needs are met.

Correct answer: B

Rationale: Administering an analgesic before whirlpool therapy is the priority intervention in this scenario. Whirlpool therapy for debridement can be painful for the client with partial-thickness burns. Administering an analgesic before the procedure helps manage pain during the debridement process, ensuring the client's comfort. Applying a sterile dressing (Choice A) may be necessary after the whirlpool therapy but is not the immediate pre-transport intervention. Encouraging the client to drink fluids (Choice C) and ensuring nutritional needs are met (Choice D) are important aspects of care but are not specifically related to preparing the client for whirlpool therapy.

3. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection the previous day and notes that 1,000 mL of gastric secretions were collected in the last 4 hours. The nurse should assess the client for symptoms of which related problem?

• A. Respiratory acidosis.
• B. Metabolic alkalosis.
• C. Hypoglycemia.
• D. Hyperkalemia.

Correct answer: B

Rationale: The correct answer is B: Metabolic alkalosis. Loss of gastric secretions can lead to metabolic alkalosis due to the loss of hydrochloric acid. This can result in an increase in blood pH levels. Respiratory acidosis (choice A) is caused by retention of carbon dioxide, not related to the loss of gastric secretions. Hypoglycemia (choice C) is a low blood sugar level and is not directly related to the loss of gastric secretions. Hyperkalemia (choice D) is an elevated potassium level in the blood and is not typically associated with the loss of gastric secretions.

4. The nurse is caring for a client with myasthenia gravis. Which symptom is most important for the nurse to report to the healthcare provider?

• A. Diplopia (double vision)
• B. Difficulty swallowing
• C. Weakness in the legs
• D. Fatigue

Correct answer: B

Rationale: In a client with myasthenia gravis, difficulty swallowing is the most crucial symptom to report to the healthcare provider. This is because it can lead to aspiration, a severe complication in these clients. Diplopia (double vision) and weakness in the legs are common symptoms of myasthenia gravis but are not as immediately dangerous as difficulty swallowing. Fatigue is also a common symptom in myasthenia gravis but does not pose the same risk of aspiration as difficulty swallowing.

5. What assessment findings should lead the nurse to suspect Down syndrome in a newborn?

• A. Hypertonia and dark skin
• B. Low-set ears and a simian crease
• C. Inner epicanthal folds and a high, domed forehead
• D. Long, thin fingers and excessive hair

Correct answer: B

Rationale: The correct answer is B: 'Low-set ears and a simian crease.' These are key physical characteristics commonly seen in newborns with Down syndrome. Low-set ears, along with a simian crease (a single palmar crease), are indicative of Down syndrome. Choices A, C, and D are incorrect because hypertonia, dark skin, inner epicanthal folds, a high, domed forehead, long, thin fingers, and excessive hair are not specific features associated with Down syndrome in newborns. Therefore, the presence of low-set ears and a simian crease should raise suspicion for Down syndrome and prompt further evaluation.

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