Nursing Elites

1. A client with chronic kidney disease has an arteriovenous (AV) fistula in the left forearm. Which observation by the nurse indicates that the fistula is patent?

• A. Distended, tortuous veins in the left hand
• B. The left radial pulse is 2+ bounding
• C. Auscultation of a thrill on the left forearm
• D. Assessment of a bruit on the left forearm

Correct answer: C

Rationale: Auscultation of a thrill on the left forearm is the correct observation indicating that the AV fistula is patent. A thrill is a palpable vibration or buzzing sensation felt over the fistula, indicating the presence of blood flow. Choices A, B, and D do not directly assess the patency of the fistula. Distended, tortuous veins in the left hand may indicate venous hypertension; a bounding radial pulse could suggest increased blood flow through an artery, but it does not confirm fistula patency; assessment of a bruit indicates turbulent blood flow, but it does not confirm patency.

2. A client receives a prescription for acetylcysteine (Mucomyst) 1.4 grams per nasogastric tube q4 hours. Acetylcysteine is available as a 10% solution (10 grams/100ml). How many ml of the 10% solution should the nurse administer per dose?

• A. 7
• B. 10
• C. 14
• D. 1.4 grams of acetylcysteine is equivalent to 14 ml of a 10% solution.

Correct answer: D

Rationale: To determine the amount of the 10% acetylcysteine solution to administer, convert the 1.4 grams to milligrams (1.4 grams = 1400 mg). Then, as the 10% solution contains 10 grams (10,000 mg) per 100 ml, it means there are 1000 mg of acetylcysteine in every 10 ml of the solution (10,000 mg / 100 ml = 100 mg/ml). Therefore, to administer 1400 mg (1.4 grams) of acetylcysteine, the nurse should give 14 ml of the 10% solution. Choices A, B, and C are incorrect as they do not accurately convert the amount of acetylcysteine to the corresponding volume of the 10% solution.

3. A 20-year-old male client is diagnosed with Ewing’s sarcoma following an examination for a knee injury. Which instruction is most important for the nurse to provide the client?

• A. Take analgesics regularly to manage pain
• B. Notify the healthcare provider if the swelling worsens
• C. Avoid weight-bearing on the affected knee until the injury heals
• D. Seek treatment for the sarcoma immediately

Correct answer: D

Rationale: The most crucial instruction for the nurse to provide the client is to seek treatment for the sarcoma immediately. Ewing's sarcoma is a type of cancer that necessitates prompt and aggressive treatment for the best possible outcome. While managing pain (Choice A) and monitoring swelling (Choice B) are important, addressing the underlying sarcoma is the priority. Instructing the client to avoid weight-bearing (Choice C) is not directly related to the treatment of Ewing's sarcoma and may not be the most critical instruction at this point.

4. The practical nurse (PN) is assigned to work with three registered nurses (RN) who are caring for neurologically compromised clients. The client with which change in status is best to assign to the PN?

• A. Diabetic ketoacidosis whose Glasgow Coma Scale score changed from 10 to 7
• B. Subdural hematoma whose blood pressure changed from 150/80 mmHg to 170/60 mmHg
• C. Myxedema coma whose blood pressure changed from 80/50 mmHg to 70/40 mmHg
• D. Viral meningitis whose temperature changed from 101° F (38.3 C) to 102° F (38.9C)

Correct answer: D

Rationale: The correct answer is D because viral meningitis with a slight increase in temperature is less acute and complex compared to the other conditions. This change in temperature does not indicate a critical or urgent situation requiring immediate attention or intervention beyond the scope of a practical nurse. Choices A, B, and C present more significant changes in health status such as a decrease in Glasgow Coma Scale score, an increase in intracranial pressure indicated by blood pressure changes, and a significant drop in blood pressure, respectively. These changes require closer monitoring and intervention by registered nurses due to the higher acuity and complexity of care needed for these conditions.

5. A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse to recommend to the client?

• A. Plain yogurt sweetened with raw honey
• B. Peanuts in the shell, roasted or unroasted
• C. Aged farmer’s cheese with celery sticks
• D. Baked apples topped with dried raisins

Correct answer: A

Rationale: The correct answer is A: Plain yogurt sweetened with raw honey. This option is the best choice for a client with severe neutropenia undergoing chemotherapy because it is less likely to harbor harmful bacteria, which could cause infections due to the weakened immune system. Peanuts in the shell (choice B) may carry a risk of contamination, while aged farmer's cheese with celery sticks (choice C) and baked apples topped with dried raisins (choice D) may not be as safe as plain yogurt for a client with severe neutropenia.

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