Nursing Elites

1. A client receiving opiates for pain management was initially sedated but is no longer sedated after three days. What action should the nurse take?

• A. Initiate additional non-pharmacological pain management techniques.
• B. Notify the provider that a dosage adjustment is needed.
• C. No action is needed at this time.
• D. Contact the provider to request an alternate method of pain management.

Correct answer: C

Rationale: The correct answer is C: No action is needed at this time. Sedation from opiates commonly decreases as the body adjusts to the medication. It is a positive sign that the sedation has resolved, indicating the client is tolerating the current dosage well. Initiating additional non-pharmacological pain management techniques (Choice A) is unnecessary since the current pain management regimen is effective. Notifying the provider for a dosage adjustment (Choice B) is premature and not indicated when the sedation has resolved. Contacting the provider to request an alternate method of pain management (Choice D) is excessive and not warranted in this situation where the client is no longer sedated and the current pain management plan is effective.

2. A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily, but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated?

• A. Urine specific gravity of 1.035
• B. Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030
• C. Polyuria
• D. Hypotension

Correct answer: B

Rationale: Oliguria (reduced urine output), increased urine concentration, and a urine specific gravity greater than 1.030 are indicative of dehydration, particularly in clients using diuretics excessively. Choice A is incorrect because a urine specific gravity of 1.035 is high, indicating concentrated urine but not specifically dehydration. Choice C, polyuria, refers to increased urine output and is not consistent with dehydration. Choice D, hypotension, is a sign of fluid volume deficit but is not specific to dehydration as described in the scenario.

3. A nurse enters a client’s room and sees smoke coming from the trash can. Which action should the nurse take first?

• A. Extinguish the fire
• B. Activate the fire alarm
• C. Evacuate the room
• D. Call the client’s family

Correct answer: C

Rationale: In a fire emergency, the priority for the nurse is to ensure safety. The correct first action is to evacuate the room, following the RACE protocol, which stands for Rescue, Alarm, Contain, and Extinguish/Evacuate. Activating the fire alarm alerts others, extinguishing the fire can escalate the situation if not done correctly, and calling the client's family is not a priority in this emergency scenario.

4. A client with chronic kidney disease is about to start hemodialysis. Which of the following instructions should the nurse include?

• A. Increase protein intake between dialysis sessions
• B. Reduce potassium intake
• C. Avoid iron supplements
• D. Expect weight gain after each dialysis session

Correct answer: B

Rationale: The correct answer is to instruct the client to reduce potassium intake. Clients with chronic kidney disease should limit potassium intake to prevent hyperkalemia, as the kidneys may struggle to remove excess potassium. Increasing protein intake between dialysis sessions (Choice A) is not recommended as it can increase urea production, adding to the workload of the kidneys. Avoiding iron supplements (Choice C) is not necessary unless iron levels are high. Expecting weight gain after each dialysis session (Choice D) is incorrect as patients typically experience weight loss due to fluid removal during dialysis.

5. A nurse is caring for a group of patients. Which of the following clients should the nurse refer to a social worker?

• A. A patient who requests to secure an emergency notification system in the home.
• B. A client who requires placement in an assisted living facility.
• C. A patient who requests to get school assignments while hospitalized on a pediatric unit.
• D. A patient who is experiencing food insecurity.

Correct answer: B

Rationale: The correct answer is B because social workers are involved in arranging care services like placement in assisted living facilities. This client's need for placement in an assisted living facility requires the expertise and assistance of a social worker. Choices A, C, and D do not necessarily require the intervention of a social worker. Choice A can be addressed by a nurse or healthcare provider, choice C can be managed by hospital staff or educators, and choice D may involve a nutritionist or community outreach programs.

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