Nursing Elites

1. An 85-year-old client is diagnosed with hypernatremia due to lack of fluid intake and dehydration. The nurse knows that symptoms of hypernatremia include:

• A. Lack of thirst
• B. Pale skin
• C. Hypertension
• D. Swollen tongue

Correct answer: D

Rationale: Hypernatremia among elderly clients can result from dehydration and insufficient fluid intake, leading to sodium levels above 145 mEq/L. Common symptoms of hypernatremia include mental status changes, a thick or swollen tongue, excessive thirst, and flushed skin. Choice A, 'Lack of thirst,' is incorrect as hypernatremia typically presents with excessive thirst. Choice B, 'Pale skin,' is not a typical symptom of hypernatremia. Choice C, 'Hypertension,' is not a direct symptom of hypernatremia and is more commonly associated with other conditions like hypertension itself.

2. Which of the following types of dressing changes works as a form of wound debridement?

• A. Dry dressing
• B. Transparent dressing
• C. Composite dressing
• D. Wet to dry dressing

Correct answer: D

Rationale: The correct answer is 'Wet to dry dressing.' Wet to dry dressing is a method of wound debridement that involves applying sterile soaked gauze to the wound, allowing it to dry and stick to the wound. When the dressing is removed, it pulls away drainage and debris, aiding in wound debridement. Choice A, 'Dry dressing,' does not actively assist in debridement as it does not collect or remove debris from the wound. Choice B, 'Transparent dressing,' is primarily used for maintaining a moist environment and wound observation, not for debridement. Choice C, 'Composite dressing,' combines multiple layers for different wound care purposes but is not specifically designed for debridement like wet to dry dressing.

3. Which of the following is the most common type of malignant brain tumor in the United States?

• A. Meningioma
• B. Glioblastoma multiforme
• C. Acoustic neuroma
• D. Pituitary adenoma

Correct answer: B

Rationale: Glioblastoma multiforme is the most common malignant brain tumor in the United States, accounting for a significant portion of cases. It is known for its aggressive nature and poor prognosis. Surgical resection, followed by radiation and chemotherapy, is the standard treatment approach for glioblastoma multiforme. Meningioma, acoustic neuroma, and pituitary adenoma are also types of brain tumors but are not as common as glioblastoma multiforme in the United States.

4. The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care?

• A. Infection.
• B. Poor body image.
• C. Decreased urinary elimination.
• D. Cracking oral mucous membranes.

Correct answer: A

Rationale: In a neonate with gastroschisis, the bowel herniates through a defect in the abdominal wall without a covering membrane, which puts the neonate at high risk of infection. Immediate surgical repair is necessary due to the vulnerability of the exposed bowel to infection. Therefore, the most critical concern for the nurse to address in the plan of care of a neonate with gastroschisis is preventing infection. Poor body image is not a priority in neonatal care as neonates do not have body image concerns. Decreased urinary elimination is not typically a direct consequence of gastroschisis as it primarily affects the gastrointestinal system, not the genitourinary system. Cracking oral mucous membranes are not relevant to gastroschisis as it involves the lower gastrointestinal system, not the oral cavity.

5. The healthcare provider calculates the IV flow rate for a patient receiving lactated Ringer's solution. The patient needs to receive 2000mL of Lactated Ringer's over 36 hours. The IV infusion set has a drop factor of 15 drops per milliliter. How many drops per minute should the healthcare provider set the IV to deliver?

• A. 8
• B. 10
• C. 14
• D. 18

Correct answer: C

Rationale: To determine the drops per minute, we use the formula Drops Per Minute = (Milliliters x Drop Factor) / Time in Minutes. In this case, Drops Per Minute = (2000mL x 15 drops/mL) / (36 hours x 60 minutes/hour) = 30000 / 2160 = 13.89 (approximately 14). Therefore, the correct answer is 14 drops per minute. Choice A (8), Choice B (10), and Choice D (18) are incorrect as they do not correctly calculate the drops per minute based on the given information.

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