Nursing Elites

1. When administering intravenous electrolyte solution, which of the following precautions should the nurse take?

• A. Infuse hypertonic solutions cautiously.
• B. Mix no more than 60 mEq of potassium per liter of fluid.
• C. Prevent infiltration of calcium, which causes tissue necrosis and sloughing.
• D. Monitor the client's digitalis dosage for potential adjustments due to IV calcium administration.

Correct answer: C

Rationale: When administering intravenous electrolyte solutions, it is crucial to prevent infiltration of calcium to avoid tissue necrosis and sloughing. Hypertonic solutions should be infused cautiously (Choice A) to prevent adverse effects. The correct amount of potassium to be mixed in a liter of fluid is no more than 60 mEq, making Choice B incorrect. While monitoring the client's digitalis dosage for potential adjustments due to IV calcium administration is important, the statement suggesting an increased dosage is incorrect as IV calcium diminishes digitalis's action, making Choice D incorrect.

2. For a client with suspected appendicitis, where should the nurse expect to find abdominal tenderness?

• A. upper right
• B. upper left
• C. lower right
• D. lower left

Correct answer: C

Rationale: The correct answer is C: lower right. Abdominal tenderness in the lower-right quadrant is a classic symptom of appendicitis. This tenderness is known as McBurney's point, which is located in the lower-right quadrant of the abdomen. Choices A, B, and D are incorrect because the tenderness associated with appendicitis is typically localized to the lower-right quadrant.

3. A client had a C5 spinal cord contusion that resulted in quadriplegia. Two days after the injury occurred, the nurse sees his mother crying in the waiting room. The mother asks the nurse whether her son will ever play football again. Which of the following is the best initial response?

• A. "Given time and motivation, your son may regain some function, but I will seek more information from the physician."?
• B. Maintain a calm demeanor and speech pattern while addressing the mother's concerns.
• C. "I'm not sure, but I'll call the physician to discuss this with you promptly."?
• D. "It's not beneficial for your son if you get upset."?

Correct answer: C

Rationale: The best initial response in this situation is to acknowledge the mother's concern, express uncertainty, and offer to obtain more information from the physician. By saying, "I'm not sure, but I'll call the physician to discuss this with you promptly,"? the nurse demonstrates empathy, honesty, and a commitment to providing accurate information. Offering vague reassurance (Choice A) may raise false hopes as outcomes for spinal cord injuries are unpredictable. While maintaining a calm demeanor (Choice B) is important, it does not directly address the mother's immediate need for information. Discouraging the mother from feeling upset (Choice D) is dismissive of her emotions and does not address her question, which is seeking information about her son's prognosis.

4. A client asks a nurse working in a dental office what type of drug the dentist uses to provide anesthesia during the extraction of the client's wisdom teeth. The dentist uses an anesthetic gas, also known as laughing gas. This agent is:

• A. nitrous oxide.
• B. nitrogen.
• C. nitric oxide.
• D. nitrogen dioxide.

Correct answer: A

Rationale: The correct answer is nitrous oxide. Nitrous oxide is commonly known as laughing gas and is used as an anesthetic gas for procedures like dental extractions. It produces analgesia and mild euphoria without loss of consciousness. Nitrogen is a nonmetallic element found in air, while nitric oxide is a vasodilator produced from L-arginine. Nitrogen dioxide is a poisonous gas found in smog and exhaust fumes and is not used for anesthesia.

5. A patient had a pneumonectomy to the right lung performed 48 hours ago. Which of the following conditions most likely exists?

• A. Decreased breath sound volume
• B. Elevated tidal volume
• C. Elevated respiratory capacity
• D. Wheezing

Correct answer: A

Rationale: After a pneumonectomy, where a lung is surgically removed, there will be a decrease in breath sound volume on the affected side due to reduced airflow. This reduction in breath sound volume is expected as there is less lung tissue to produce sound. Choices B, C, and D are incorrect. Elevated tidal volume and respiratory capacity are not expected after a pneumonectomy, and wheezing is more commonly associated with conditions like asthma or bronchitis, not a recent pneumonectomy.

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