Nursing Elites

1. A client has a urine specific gravity of 1.040. What action should the nurse take?

• A. Obtain a urine culture and sensitivity.
• B. Place the client on restricted fluids.
• C. Assess the client’s creatinine level.
• D. Increase the client’s fluid intake.

Correct answer: D

Rationale: A urine specific gravity of 1.040 is higher than the normal range (1.005 to 1.030) and can indicate dehydration, decreased kidney blood flow, or the presence of antidiuretic hormone. In this situation, the priority action should be to increase the client's fluid intake to address the high specific gravity. Obtaining a urine culture, placing the client on restricted fluids, or assessing the creatinine level would not directly address the underlying issue of high urine specific gravity caused by dehydration or other factors.

2. A client with polycystic kidney disease (PKD is being assessed by a nurse. Which assessment finding should prompt the nurse to immediately contact the healthcare provider?

• A. Flank pain
• B. Periorbital edema
• C. Bloody and cloudy urine
• D. Enlarged abdomen

Correct answer: B

Rationale: Periorbital edema would not typically be associated with polycystic kidney disease (PKD) and could indicate other underlying issues that require immediate attention. Flank pain and an enlarged abdomen are common findings in PKD due to kidney enlargement and displacement of other organs. Bloody or cloudy urine can result from cyst rupture or infection, which are expected in PKD. Therefore, periorbital edema is the most alarming finding in this scenario and warrants prompt notification of the healthcare provider.

3. A healthcare professional is reviewing the results of serum laboratory studies of a client with suspected hepatitis. Which increased parameter is interpreted as the most specific indicator of this disease?

• A. Hemoglobin
• B. Serum bilirubin
• C. Blood urea nitrogen (BUN)
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Serum bilirubin is the most specific indicator of hepatitis as it reflects liver dysfunction. Hemoglobin, blood urea nitrogen (BUN), and erythrocyte sedimentation rate (ESR) are not specific to hepatitis. Hemoglobin measures the oxygen-carrying capacity of red blood cells, BUN evaluates kidney function, and ESR is a nonspecific marker of inflammation or infection.

4. A client who has just undergone a skin biopsy is listening to discharge instructions from the nurse. The nurse determines that the client has misunderstood the directions if the client indicates that as part of aftercare he plans to:

• A. Use the antibiotic ointment as prescribed
• B. Return in 7 days to have the sutures removed
• C. Apply cool compresses to the site twice a day for 20 minutes
• D. Call the physician if excessive drainage from the wound occurs

Correct answer: C

Rationale: The correct answer is C. Applying cool compresses to the site twice a day for 20 minutes is not a recommended aftercare practice for a skin biopsy. After a skin biopsy, it is important to keep the dressing dry and in place for a minimum of 8 hours. Choice A is correct as using the antibiotic ointment as prescribed is a common post-biopsy instruction to prevent infection. Choice B is also correct as returning in 7 days to have the sutures removed is part of the typical follow-up care after a skin biopsy. Choice D is correct as it is important to call the physician if excessive drainage from the wound occurs to prevent complications.

5. An older female client has normal saline infusing at 45 mL/hour. She complains of pain at the insertion site of the IV catheter. There is no redness or edema around the IV site. Which action should the nurse take?

• A. Determine which IV medications have recently been administered.
• B. Explain that without redness or edema, there is no need to re-start the IV.
• C. Consult with the healthcare provider about the best location to start a new IV.
• D. Convert the IV to a saline lock and continue to monitor the site.

Correct answer: D

Rationale: Converting the IV to a saline lock and continuing to monitor the site is the correct action in this scenario. When a client complains of pain at the IV insertion site without redness or edema, it may indicate phlebitis or irritation. Replacing the IV may not be necessary if there are no signs of infection or infiltration. Determining the IV medications administered or consulting with the healthcare provider to start a new IV are not immediate actions required for pain management at the insertion site. Therefore, the most appropriate intervention is to convert the IV to a saline lock and closely observe for any changes or complications.

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