Nursing Elites

1. A client with a history of peptic ulcer disease (PUD) is admitted after vomiting bright red blood several times over the course of 2 hours. In reviewing the laboratory results, the nurse finds the client's hemoglobin is 12 g/dL (120g/L) and the hematocrit is 35% (0.35). Which action should the nurse prepare to take?

• A. Continue monitoring for blood loss
• B. Administer 1,000 mL (1L) of normal saline
• C. Transfuse 2 units of platelets
• D. Prepare the client for emergency surgery

Correct answer: D

Rationale: The correct answer is to prepare the client for emergency surgery. The client's presentation with bright red blood in vomitus suggests active bleeding, which is a medical emergency. With a hemoglobin of 12 g/dL and a hematocrit of 35%, the client is likely experiencing significant blood loss that may require surgical intervention to address the source of bleeding. Continuing to monitor for blood loss (Choice A) is not appropriate in this acute situation where immediate action is necessary. Administering normal saline (Choice B) may help with fluid resuscitation but does not address the underlying cause of bleeding. Transfusing platelets (Choice C) is not indicated in this scenario as platelets are involved in clot formation and are not the primary treatment for active bleeding in this context.

2. The healthcare provider is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the healthcare provider expect the patient to experience?

• A. Inadequate drug effects
• B. Increased risk of superinfection
• C. Minimal adverse effects
• D. Slowed onset of action

Correct answer: A

Rationale: A serum drug trough level below the normal range (1.7 mcg/mL to 2.2 mcg/mL) indicates that the medication concentration is insufficient to provide therapeutic effects, leading to inadequate drug effects. A low trough level does not directly correlate with an increased risk of superinfection, minimal adverse effects, or a slowed onset of action, as these are more related to the drug's concentration within the therapeutic range.

3. During an interview with a client planning elective surgery, the client asks the nurse, 'What is the advantage of having a preferred provider organization insurance plan?' Which response is best for the nurse to provide?

• A. Neither plan allows the selection of healthcare providers or hospitals.
• B. There are fewer healthcare providers to choose from than in an HMO plan.
• C. An individual may select healthcare providers from outside of the PPO network.
• D. An individual can become a member of a PPO without belonging to a group.

Correct answer: C

Rationale: The best response for the nurse to provide is option C, as it highlights a key advantage of a preferred provider organization (PPO) insurance plan. By stating that an individual may select healthcare providers from outside of the PPO network, the nurse emphasizes the flexibility and freedom of choice that PPO plans offer. This feature allows individuals to seek care from providers who are not part of the PPO network, albeit at a higher cost. Option A is incorrect because both PPO and HMO plans allow the selection of healthcare providers, although with different restrictions. Option B is incorrect as PPO plans typically offer a larger selection of healthcare providers compared to HMO plans. Option D is incorrect as membership in a PPO usually requires affiliation with a group, such as through employment or membership in an organization.

4. When monitoring a client who is receiving tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following?

• A. Cardiac arrhythmias.
• B. Hypertension.
• C. Seizures.
• D. Hypothermia.

Correct answer: A

Rationale: The correct answer is A: Cardiac arrhythmias. Reperfusion of cardiac tissue following t-PA administration can lead to cardiac arrhythmias, necessitating resuscitation equipment. Hypertension (choice B) is a common side effect of t-PA but is not directly related to reperfusion. Seizures (choice C) and hypothermia (choice D) are not typically associated with reperfusion from t-PA administration.

5. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?

• A. Place the client on a cardiac monitor immediately.
• B. Teach the client to limit high-potassium foods.
• C. Continue to monitor the client’s intake and output.
• D. Ask to have the laboratory redraw the blood specimen.

Correct answer: A

Rationale: The best immediate action by the nurse in this situation is to place the client on a cardiac monitor immediately. A serum potassium level of 6.5 mmol/L indicates hyperkalemia, which can lead to life-threatening dysrhythmias. Monitoring the cardiac status is crucial to detect any potential arrhythmias promptly. Teaching the client to limit high-potassium foods (Choice B) may be important for long-term management, but it is not the priority at this moment. Continuing to monitor intake and output (Choice C) is important for assessing renal function but does not address the immediate risk of dysrhythmias. Asking to have the laboratory redraw the blood specimen (Choice D) is unnecessary since the current results indicate a critical situation that requires immediate action.

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