Nursing Elites

1. A healthcare provider is assessing a client with congestive heart failure. Which of the following signs should the healthcare provider monitor?

• A. Peripheral edema
• B. Decreased appetite
• C. Fatigue
• D. All of the above

Correct answer: D

Rationale: Correct! In a client with congestive heart failure, peripheral edema, decreased appetite, and fatigue are important signs to monitor as they can indicate worsening heart failure. Peripheral edema is a common sign of fluid retention due to the heart's inability to pump effectively, decreased appetite may indicate worsening heart function, and fatigue can be a result of inadequate cardiac output. Monitoring all these signs is crucial for early intervention and management. Choices A, B, and C are incorrect because monitoring only one symptom may not provide a comprehensive assessment of the client's condition.

2. A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. Which of the following medications should the nurse plan to administer?

• A. Digoxin
• B. Calcium gluconate
• C. Vitamin B6
• D. Propranolol

Correct answer: C

Rationale: The correct answer is C: Vitamin B6 (pyridoxine). Vitamin B6 is often used to treat nausea and vomiting in pregnancy, including hyperemesis gravidarum. It is considered safe for use in pregnant clients. Digoxin (Choice A) is a medication used for heart conditions, not for hyperemesis gravidarum. Calcium gluconate (Choice B) is used to treat calcium deficiencies, not nausea and vomiting in pregnancy. Propranolol (Choice D) is a beta-blocker used for conditions like hypertension and anxiety, not for hyperemesis gravidarum.

3. A nurse is caring for a client who is in preterm labor and is receiving magnesium sulfate via IV infusion. Which of the following findings indicates magnesium toxicity?

• A. Blood glucose of 150 mg/dL
• B. Urine output of 20 mL/hour
• C. Systolic blood pressure of 140 mm Hg
• D. BUN 20 mg/dL

Correct answer: B

Rationale: The correct answer is B. A urine output of 20 mL/hour is a sign of magnesium toxicity because decreased urine output can lead to accumulation of magnesium. Choices A, C, and D are not indicators of magnesium toxicity. Elevated blood glucose, high systolic blood pressure, and normal BUN levels do not specifically point towards magnesium toxicity.

4. A nurse is caring for a client who has chronic kidney disease. The nurse should identify which of the following laboratory values as an indication for hemodialysis?

• A. Glomerular filtration rate of 14 mL/min
• B. BUN 16 mg/dL
• C. Serum magnesium 1.8 mg/dL
• D. Serum phosphorus 4.0 mg/dL

Correct answer: A

Rationale: A glomerular filtration rate (GFR) of 14 mL/min indicates severely impaired kidney function, often necessitating hemodialysis to support renal function and manage fluid and electrolyte balance. A BUN level of 16 mg/dL falls within the normal range (7-20 mg/dL) and does not specifically indicate the need for hemodialysis. Serum magnesium at 1.8 mg/dL and serum phosphorus at 4.0 mg/dL are also within normal ranges and do not typically prompt the immediate need for hemodialysis in chronic kidney disease.

5. A nurse is caring for a client who has a prescription for a narcotic medication. After administering, the nurse is left with an unused portion. What should the nurse do?

• A. Store the unused medication for later use
• B. Discard the medication in a regular trash bin
• C. Discard the medication with another nurse as a witness
• D. Report the unused portion to the provider

Correct answer: C

Rationale: The correct answer is to discard the medication with another nurse as a witness. Controlled substances, such as narcotic medications, must be properly disposed of to prevent misuse or diversion. Having another nurse witness the disposal ensures accountability and follows proper protocols. Storing the unused medication for later use (Choice A) is unsafe and could lead to misuse. Discarding the medication in a regular trash bin (Choice B) is inappropriate as it does not ensure proper disposal of a controlled substance. Reporting the unused portion to the provider (Choice D) is not the immediate action needed for proper medication disposal.

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