Nursing Elites

1. Which electrolyte imbalance is most likely to cause cardiac arrhythmias?

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

Correct answer: A

Rationale: Hyperkalemia is the correct answer as it can lead to dangerous cardiac arrhythmias due to its effects on the electrical conduction of the heart. High levels of potassium can disrupt the normal electrical activity of the heart, potentially leading to life-threatening arrhythmias. Hypocalcemia (choice B) is not the most likely cause of cardiac arrhythmias compared to hyperkalemia. Hypernatremia (choice C), referring to high sodium levels, is not directly associated with causing cardiac arrhythmias. While hypokalemia (choice D), low potassium levels, can also lead to cardiac arrhythmias, hyperkalemia is the more likely culprit in causing severe disturbances in heart rhythm.

2. A client has a prescription for a transcutaneous electrical nerve stimulator (TENS) unit for pain management during the postoperative period following a lumbar laminectomy. Which information should the PN reinforce about the action of the adjuvant pain modality?

• A. The discharge of electricity will distract the client's focus from the pain.
• B. An infusion of medication into the spinal canal will block pain perception.
• C. Pain perception in the cerebral cortex is dulled by the unit's discharge of an electrical stimulus.
• D. A mild electrical stimulus on the skin surface closes the gates of nerve conduction for severe pain.

Correct answer: D

Rationale: The TENS unit works by providing a mild electrical stimulus to the skin, which helps to 'close the gate' on pain signals, reducing the perception of pain. Choice A is incorrect because distraction is not the primary mechanism of action for TENS. Choice B is incorrect as it describes a different method of pain management involving medication infusion into the spinal canal. Choice C is incorrect as it inaccurately describes the location of pain perception modulation by the TENS unit.

3. The home health nurse suspects elder abuse after observing fresh lacerations on the arms and legs of an older adult male client who lives with his daughter. Which action is most important for the nurse to take?

• A. Document the lacerations in the client's record
• B. Report findings to the supervisor for referral to adult protective services
• C. Ask the daughter who has been taking care of the client on a daily basis
• D. Apply dry dressings after cleansing the wounds

Correct answer: B

Rationale: In cases where elder abuse is suspected, the most critical action for the nurse to take is to report the findings to the supervisor for referral to adult protective services. This step is essential to protect the client from further harm and ensure their safety. Documenting the lacerations, as suggested in choice A, is important but not as urgent as ensuring immediate intervention by reporting the abuse. Asking the daughter for information, as in choice C, may not be effective if she is the abuser. Applying dressings, as in choice D, is a lower priority compared to taking action to address the suspected abuse.

4. Before administering an antibiotic that can cause nephrotoxicity, which lab value is most important for the nurse to review?

• A. Hemoglobin and Hematocrit
• B. Serum Calcium
• C. Serum Creatinine
• D. WBC

Correct answer: C

Rationale: The correct answer is C: Serum Creatinine. Serum creatinine is a key indicator of kidney function. Reviewing this value is crucial as it helps assess the client's risk for nephrotoxicity before administering the antibiotic. Elevated serum creatinine levels can indicate impaired kidney function, which would increase the risk of nephrotoxicity. Choices A, B, and D are not as directly related to kidney function and nephrotoxicity. Hemoglobin and hematocrit levels assess for anemia, serum calcium levels monitor calcium balance, and WBC count evaluates for infections. While these values are important for overall patient assessment, they are not as specific to assessing nephrotoxicity risk as serum creatinine.

5. In which type of cardiomyopathy does septal involvement occur?

• A. Congestive
• B. Dilated
• C. Hypertrophic
• D. Restrictive

Correct answer: C

Rationale: Septal involvement is a characteristic feature of hypertrophic cardiomyopathy, where the septal wall of the heart thickens. This thickening can obstruct blood flow out of the heart, leading to complications such as arrhythmias and heart failure. This differentiates it from other types of cardiomyopathy. In congestive cardiomyopathy (choice A), the heart's chambers become enlarged and weakened, but there is no specific mention of septal involvement. Dilated cardiomyopathy (choice B) involves dilation and impaired contraction of the heart chambers, not specifically septal thickening. Restrictive cardiomyopathy (choice D) is characterized by stiffening of the heart muscle, affecting its ability to fill properly, without direct involvement of the septum.

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