Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reviewing the laboratory report for a client who has acute pancreatitis. The nurse should identify that which of the following findings indicates an improvement in the client's condition?
A. Increased serum amylase
Increased serum amylase is a common finding in acute pancreatitis, and its decrease would be a positive sign. However, lipase is a more specific marker for pancreatic injury.
B. Increased C-reactive protein
Increased C-reactive protein is a marker of inflammation and would not necessarily indicate improvement in pancreatitis.
C. Decreased serum lipase
Decreased serum lipase indicates improvement in the pancreatic injury and is a positive sign.
D. Decreased platelets
Decreased platelets would not specifically indicate improvement in acute pancreatitis.
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Full Explanation
Choice A rationale:
Increased serum amylase is a common finding in acute pancreatitis, and its decrease would be a positive sign. However, lipase is a more specific marker for pancreatic injury.
Choice B rationale:
Increased C-reactive protein is a marker of inflammation and would not necessarily indicate improvement in pancreatitis.
Choice C rationale:
Decreased serum lipase indicates improvement in the pancreatic injury and is a positive sign.
Choice D rationale:
Decreased platelets would not specifically indicate improvement in acute pancreatitis.
Similar Questions
A nurse is reviewing the medical records of a group of clients who are receiving chemotherapy. The nurse should identify that which of the following clients is at greatest risk for infection?
A. A 64-year-old client who is taking estrogen supplements
Taking estrogen supplements does not significantly increase infection risk in clients receiving chemotherapy.
B. A 70-year-old client who has COPD
A 70-year-old client with chronic obstructive pulmonary disease (COPD) is at greatest risk for infection because advanced age and chronic lung disease both impair immune function and increase susceptibility to respiratory infections, especially during chemotherapy.
C. A 28-year-old client who has a left arm fracture
A left arm fracture may increase local infection risk, but it does not pose as high a systemic infection risk as COPD in an older adult.
D. A 53-year-old client who has a thin build
Having a thin build does not inherently increase infection risk in the context of chemotherapy.
Full Explanation
A. Taking estrogen supplements does not significantly increase infection risk in clients receiving chemotherapy.
B. A 70-year-old client with chronic obstructive pulmonary disease (COPD) is at greatest risk for infection because advanced age and chronic lung disease both impair immune function and increase susceptibility to respiratory infections, especially during chemotherapy.
C. A left arm fracture may increase local infection risk, but it does not pose as high a systemic infection risk as COPD in an older adult.
D. Having a thin build does not inherently increase infection risk in the context of chemotherapy.
A nurse is providing teaching about palliative care to the family of a client who is approaching death. Which of the following information should the nurse include in the teaching?
A. Awaken the client frequently throughout the day.
Awakening the client frequently throughout the day is not necessary and can disturb their rest and comfort.
B. Keep the client warm by applying an electric blanket.
Using an electric blanket can increase the risk of burns or overheating in a client who is approaching death and may have reduced ability to regulate body temperature.
C. Position the client on their side with the head of bed elevated.
Positioning the client on their side with the head of the bed elevated can facilitate drainage of respiratory secretions, maintain airway patency, and provide comfort.
D. Encourage the client to eat soft foods intermittently.
Encouraging the client to eat soft foods intermittently may not be relevant, as the client's ability to eat and swallow may be limited in the end stages of life.
Full Explanation
Choice A rationale:
Awakening the client frequently throughout the day is not necessary and can disturb their rest and comfort.
Choice B rationale:
Using an electric blanket can increase the risk of burns or overheating in a client who is approaching death and may have reduced ability to regulate body temperature.
Choice C rationale:
Positioning the client on their side with the head of the bed elevated can facilitate drainage of respiratory secretions, maintain airway patency, and provide comfort.
Choice D rationale:
Encouraging the client to eat soft foods intermittently may not be relevant, as the client's ability to eat and swallow may be limited in the end stages of life.
A nurse in an urgent care facility is assessing a client who is currently receiving outpatient treatment for anorexia nervosa. Which of the following client data should indicate to the nurse that the client requires acute care admission?
A. Blood pressure 78/60 mm Hg
A blood pressure of 78/60 mm Hg is indicative of hypotension which is a common complication of anorexia nervosa. However. the low body temperature takes precedence
B. Weight loss 20% over last 6 months
Weight loss of 20% over the last 6 months is concerning but may not be an immediate indicator for acute care admission.
C. Apical pulse rate 50/min
An apical pulse rate of 50/min is bradycardia, which can be a result of anorexia nervosa, but it may not be an immediate indicator for acute care admission unless the client is symptomatic.
D. Body temperature 35.5° C (95.9°F)
A body temperature of 35.5°C (95.9°F) is below a normal range signfyng hypothermia which needs immedate intervention.
Full Explanation
Choice A rationale:
A blood pressure of 78/60 mm Hg is indicative of hypotension which is a common complication of anorexia nervosa. However. the low body temperature takes precedence
Choice B rationale:
Weight loss of 20% over the last 6 months is concerning but may not be an immediate indicator for acute care admission.
Choice C rationale:
An apical pulse rate of 50/min is bradycardia, which can be a result of anorexia nervosa, but it may not be an immediate indicator for acute care admission unless the client is symptomatic.
Choice D rationale:
A body temperature of 35.5°C (95.9°F) is below a normal range signfyng hypothermia which needs immedate intervention.