Nursing Elites

1. A client receives a prescription for 1 liter of lactated Ringer's intravenously to be infused over 6 hours. How many mL/hr should the nurse program the infusion pump to deliver? (Enter numerical value only. If rounding is needed, round to the nearest whole number.)

• A. 167 mL/hr
• B. 200 mL/hr
• C. 83 mL/hr
• D. 111 mL/hr

Correct answer: A

Rationale: The correct infusion rate is 167 mL/hr. This is calculated by dividing the total volume (1000 mL) by the total time (6 hours), resulting in 166.67 mL/hr, which should be rounded to the nearest whole number as 167 mL/hr. This calculation ensures a steady infusion rate over the specified time frame. Choices B, C, and D are incorrect as they do not accurately reflect the correct calculation based on the volume and time provided in the prescription.

2. After confirming that liquids are allowed, which assessment action should the nurse consider a priority for a client who is fully awake after a gastroscopy?

• A. Listen to bilateral lung and bowel sounds.
• B. Obtain the client's pulse and blood pressure.
• C. Assist the client to the bathroom to void.
• D. Check the client's gag and swallow reflexes.

Correct answer: D

Rationale: After a gastroscopy, it is crucial for the nurse to prioritize checking the client's gag and swallow reflexes before allowing them to drink anything. This is because the effects of local anesthesia need to dissipate, and the airway's protective reflexes, including the gag and swallow reflexes, must have returned to prevent aspiration. Listening to lung and bowel sounds (Choice A) may be important but does not take precedence over ensuring the client's safety post-gastroscopy. Obtaining the client's pulse and blood pressure (Choice B) is also important but not the priority in this scenario. Assisting the client to the bathroom to void (Choice C) is a routine nursing action and is not directly related to the immediate safety concern of checking the client's gag and swallow reflexes post-gastroscopy.

3. A client has a long history of hypertension. Which category of medication would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

• A. Antibiotic
• B. Histamine blocker
• C. Bronchodilator
• D. Angiotensin-converting enzyme (ACE) inhibitor

Correct answer: D

Rationale: The correct answer is D, Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By blocking this conversion, ACE inhibitors promote vasodilation and improve perfusion to the kidneys. Additionally, ACE inhibitors block the breakdown of bradykinin and prostaglandin, further contributing to vasodilation. They also lead to increased renin and decreased aldosterone levels. These effects help in reducing blood pressure and protecting the kidneys in clients with hypertension. Antibiotics are used to fight infections, histamine blockers reduce inflammation, and bronchodilators widen the bronchi, none of which address the underlying processes involved in slowing the progression of chronic kidney disease (CKD) in hypertensive clients.

4. A client who experienced partial-thickness burns involving over 50% body surface area (BSA) 2 weeks ago has several open wounds and develops watery diarrhea. The client's blood pressure is 82/40 mmHg, and temperature is 96°F (36.6°C). Which action is most important for the nurse to take?

• A. Increase the room temperature.
• B. Assess the oxygen saturation.
• C. Continue to monitor vital signs.
• D. Notify the rapid response team.

Correct answer: D

Rationale: In this scenario, the client is presenting with signs of sepsis, such as hypotension, hypothermia, and a recent history of partial-thickness burns with open wounds. The development of watery diarrhea further raises suspicion for sepsis. With a blood pressure of 82/40 mmHg and a low temperature of 96°F (36.6°C), the nurse should recognize the potential for septic shock. Notifying the rapid response team is crucial in this situation as the client requires immediate intervention and management to prevent deterioration and address the underlying septic process. Increasing the room temperature (Choice A) is not the priority as the low body temperature is likely due to systemic vasodilation and not environmental factors. While assessing oxygen saturation (Choice B) is important, the client's hypotension and hypothermia take precedence. Continuing to monitor vital signs (Choice C) alone is insufficient given the critical condition of the client and the need for prompt action to address the sepsis and potential septic shock.

5. The healthcare provider prescribes diagnostic tests for a client with pneumonia identified on a chest X-ray. Which diagnostic test should the nurse review for implementation to guide the most therapeutic treatment of pneumonia?

• A. Sputum culture and sensitivity
• B. Blood cultures
• C. Arterial blood gases (ABG)
• D. Computerized tomography (CT) of the chest

Correct answer: A

Rationale: Sputum culture and sensitivity is the most appropriate diagnostic test for pneumonia as it helps in identifying the causative organism, which is crucial for guiding the selection of the most effective antibiotic therapy. Blood cultures (choice B) are more useful in identifying systemic infections rather than pneumonia specifically. Arterial blood gases (ABG) (choice C) are helpful in assessing oxygenation but do not directly aid in identifying the causative organism. Computerized tomography (CT) of the chest (choice D) is useful for evaluating structural abnormalities in the lungs but is not the initial test of choice for diagnosing pneumonia.

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