Nursing Elites

1. A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for excess fluid volume?

• A. The client taking diuretics
• B. The client with renal failure
• C. The client with an ileostomy
• D. The client who requires gastrointestinal suctioning

Correct answer: B

Rationale: The correct answer is B. Clients with renal failure are unable to excrete fluids effectively, leading to an increased risk of fluid volume excess. Option A, the client taking diuretics, would be at risk for fluid volume deficit due to increased urine output caused by the diuretics. Option C, the client with an ileostomy, is at risk for fluid volume deficit due to increased output from the ileostomy. Option D, the client who requires gastrointestinal suctioning, may be at risk for dehydration, but not specifically excess fluid volume.

2. A healthcare professional reviews a client's electrolyte laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the healthcare professional note on the electrocardiogram as a result of the laboratory value?

• A. U waves
• B. Absent P waves
• C. Elevated T waves
• D. Elevated ST segment

Correct answer: A

Rationale: The correct answer is A: U waves. A low potassium level (hypokalemia) can manifest as U waves on an ECG. U waves are small, extra deflections seen after the T wave and may indicate cardiac irritability. Absent P waves (Choice B) are associated with conditions like atrial fibrillation. Elevated T waves (Choice C) can be seen in hyperkalemia, not hypokalemia. Elevated ST segment (Choice D) is not typically associated with low potassium levels but can be seen in conditions like myocardial infarction.

3. Which of the following best describes the nurse's responsibility in obtaining informed consent?

• A. The nurse is responsible for ensuring that the patient understands the procedure and has the opportunity to ask questions.
• B. The nurse should ensure that the patient signs the consent form before the procedure begins.
• C. The nurse is responsible for witnessing the patient sign the consent form and documenting the event.
• D. The nurse should delegate the task of obtaining informed consent to another healthcare provider.

Correct answer: A

Rationale: The correct answer is A. Informed consent is a process where the healthcare provider, in this case, the nurse, ensures that the patient understands the procedure, risks, benefits, and alternatives before they agree to it. The nurse plays a crucial role in facilitating this understanding by explaining the information in a clear and understandable manner and providing the patient with the opportunity to ask questions. Choice B is incorrect because merely obtaining the patient's signature on the consent form does not ensure that the patient truly understands what they are consenting to. Choice C is not fully accurate as the nurse's role goes beyond just witnessing the signature; it involves actively ensuring the patient's comprehension. Choice D is incorrect as the responsibility of obtaining informed consent should not be delegated to another healthcare provider, as it is the nurse's duty to ensure proper communication and understanding with the patient.

4. A nurse manager has detected a potential problem with staffing and has asked staff members for their thoughts on the matter. Which of the following best describes the informational activity this manager is engaging in?

• A. Spokesperson
• B. Reporting
• C. Monitoring
• D. Job analysis and redesign

Correct answer: C

Rationale: The correct answer is C: 'Monitoring.' Monitoring involves regularly checking and observing the status of a unit or situation. In this scenario, the nurse manager is actively seeking feedback from staff members to assess and keep track of the staffing situation. Choice A, 'Spokesperson,' refers to a role where someone represents or speaks on behalf of a group or organization, which is not the primary activity in this case. Choice B, 'Reporting,' typically involves presenting information or data about a specific topic or issue but does not capture the ongoing observation and assessment aspect seen in monitoring. Choice D, 'Job analysis and redesign,' involves assessing and restructuring job roles, responsibilities, and tasks, which is not directly related to the action of monitoring staffing levels.

5. A client with type 1 diabetes mellitus presents to the emergency department with symptoms of diabetic ketoacidosis (DKA). Which of the following interventions should the nurse implement first?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct first intervention in a client with DKA is to start an intravenous line and infuse normal saline for fluid resuscitation. This is crucial to restore intravascular volume and improve perfusion, addressing the dehydration and electrolyte imbalances commonly seen in DKA. Administering insulin without addressing the dehydration can lead to further complications. Monitoring serum potassium levels is important but is not the first priority; potassium levels can shift with fluid resuscitation. Obtaining an arterial blood gas (ABG) is helpful in assessing acid-base status but is not the initial priority compared to fluid resuscitation.

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