CELBAN Reading Comprehension 3 — Questions and Answers
Question 1: A laboratory report reads: 'Serum potassium 2.9 mEq/L (Reference: 3.5–5.0 mEq/L). Patient is on digoxin 0.125 mg daily.' Why is this lab result particularly significant for this patient?
- Digoxin requires high potassium levels to be absorbed properly
- Hypokalemia increases the risk of digoxin toxicity and cardiac arrhythmias (Correct answer)
- Potassium must be above 5.0 mEq/L before digoxin can be given
- Low potassium only causes muscle cramps and is not cardiac-related
Correct answer: Hypokalemia increases the risk of digoxin toxicity and cardiac arrhythmias
Hypokalemia potentiates digoxin toxicity by increasing cardiac sensitivity to the drug, raising the risk of life-threatening arrhythmias.
Question 2: A patient's chart states: 'Allergies: Penicillin — anaphylaxis.' The physician orders 'Cephalexin 500 mg PO QID.' Based on this information, what should the nurse do FIRST?
- Administer the medication as ordered since cephalexin is not penicillin
- Contact the prescribing physician to clarify the order given the documented allergy (Correct answer)
- Substitute with a sulfonamide antibiotic instead
- Document the allergy and give half the dose to test tolerance
Correct answer: Contact the prescribing physician to clarify the order given the documented allergy
Cephalosporins share a beta-lactam ring with penicillin and carry a cross-reactivity risk; a documented anaphylaxis history requires clarification before administration.
Question 3: A clinical guideline passage reads: 'In patients with suspected sepsis, the Sepsis-3 criteria define sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. The Sequential Organ Failure Assessment (SOFA) score is used to quantify organ dysfunction.' Which set of findings would MOST suggest sepsis per this definition?
- Fever, cough, and positive sputum culture with normal blood pressure
- Suspected infection plus acute change in SOFA score of ≥2 points (Correct answer)
- WBC count above 12,000 with localized skin infection only
- Heart rate over 90 bpm and temperature of 38.1°C in a stable patient
Correct answer: Suspected infection plus acute change in SOFA score of ≥2 points
Sepsis-3 criteria define sepsis as suspected infection plus acute SOFA score increase of ≥2 indicating organ dysfunction.
Question 4: A patient education brochure about insulin states: 'Rapid-acting insulins (e.g., lispro, aspart) should be given 0–15 minutes before meals. Regular insulin should be given 30 minutes before meals. Long-acting insulins (e.g., glargine) are given once daily at the same time and have no peak.' A patient asks why their glargine is given at bedtime every day. What is the BEST explanation?
- Glargine must be given at bedtime to peak while the patient sleeps
- Once-daily dosing at a consistent time maintains steady basal insulin coverage without peaks (Correct answer)
- Bedtime dosing reduces the risk of morning hypoglycemia more than any other time
- Glargine interacts with dinner foods and must be separated from meal timing
Correct answer: Once-daily dosing at a consistent time maintains steady basal insulin coverage without peaks
Glargine provides peakless, 24-hour basal coverage; consistent once-daily timing ensures stable blood glucose levels without pronounced peaks.
Question 5: A nursing research article states: 'A randomized controlled trial (RCT) is considered the gold standard for evaluating clinical interventions. Unlike cohort studies, RCTs use random allocation to minimize selection bias and confounding variables.' A nurse is evaluating two studies: one RCT and one retrospective chart review on the same topic. Which provides stronger evidence for practice change?
- The retrospective chart review because it uses real patient data
- The RCT because random allocation reduces bias and strengthens causal inference (Correct answer)
- Both are equal if they have the same sample size
- The retrospective study because it covers a longer time period
Correct answer: The RCT because random allocation reduces bias and strengthens causal inference
RCTs are the gold standard for evaluating interventions because randomization minimizes confounding and selection bias, providing stronger causal evidence.
Question 6: A shift handover report reads: 'Mr. Chen in Room 14 is post-op day 2 following bowel resection. He has a nasogastric tube to low intermittent suction, is NPO, and receiving TPN. His abdomen remains distended and he has not passed flatus.' What does 'not passed flatus' indicate in this context?
- The patient's bowel sounds are absent, requiring urgent intervention
- Postoperative ileus may be present as bowel motility has not returned (Correct answer)
- The nasogastric tube is incorrectly placed and needs repositioning
- TPN is causing bloating and should be discontinued
Correct answer: Postoperative ileus may be present as bowel motility has not returned
Absence of flatus after bowel resection suggests postoperative ileus — the bowel has not yet regained peristaltic function.
Question 7: A consent form preamble reads: 'Informed consent requires that patients receive information in a language and format they understand, have the capacity to make decisions, and provide voluntary agreement free from coercion.' A patient who speaks limited English is presented a consent form for surgery by a surgeon in a hurry, with the family member translating. What is the PRIMARY concern?
- The surgeon should not be present during the consent process
- Family translation may not be accurate and does not ensure patient understanding or voluntary consent (Correct answer)
- The consent form should be signed only by the family member
- The patient's limited English means they cannot legally consent to surgery
Correct answer: Family translation may not be accurate and does not ensure patient understanding or voluntary consent
Family members may omit, alter, or distort information and may introduce pressure; a certified medical interpreter should be used to meet informed consent standards.
CELBAN Reading Comprehension 3
A laboratory report reads: 'Serum potassium 2.9 mEq/L (Reference: 3.5–5.0 mEq/L).
Patient is on digoxin 0.125 mg daily.' Why is this lab result particularly significant for this patient?