Nursing Elites

1. A client with a history of heart failure is receiving furosemide. Which of the following laboratory values should the nurse monitor?

• A. Sodium 140 mEq/L
• B. Calcium 9.0 mg/dL
• C. Potassium 3.2 mEq/L
• D. Chloride 100 mEq/L

Correct answer: C

Rationale: The correct answer is C: Potassium 3.2 mEq/L. A potassium level of 3.2 mEq/L is below the normal range and should be monitored in clients receiving furosemide due to the risk of hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion, leading to hypokalemia. Monitoring potassium levels is crucial to prevent complications such as cardiac arrhythmias. Choices A, B, and D are not directly impacted by furosemide therapy in the same way as potassium levels, making them less relevant for monitoring in this scenario.

2. A client in end-stage osteoporosis is reporting severe pain, with a respiratory rate of 14 per minute. Which of the following medications should the nurse expect to be the highest priority to administer to the client?

• A. Promethazine
• B. Hydromorphone
• C. Ketorolac
• D. Amitriptyline

Correct answer: B

Rationale: In a client with severe pain like the one described, the priority medication to administer is a potent analgesic like hydromorphone. Hydromorphone is a strong opioid pain medication that can effectively manage severe pain. Promethazine (Choice A) is an antiemetic and antihistamine, not a pain medication. Ketorolac (Choice C) is a nonsteroidal anti-inflammatory drug (NSAID) that is contraindicated in end-stage renal disease due to its potential to cause kidney damage. Amitriptyline (Choice D) is a tricyclic antidepressant used for conditions like depression and neuropathic pain, but it is not the first-line treatment for severe acute pain.

3. A client with a new diagnosis of type 1 diabetes mellitus is being taught by a nurse. Which of the following client statements indicates an understanding of the teaching?

• A. I will check my blood glucose levels only when I feel sick.
• B. I will inject insulin in the same spot each time.
• C. I will rotate injection sites within the same anatomical region.
• D. I will inject insulin only if my blood glucose level is above 200 mg/dL.

Correct answer: C

Rationale: The correct answer is C. Clients with type 1 diabetes should rotate injection sites within the same anatomical region to prevent lipodystrophy. Choice A is incorrect because blood glucose levels should be checked regularly, not only when feeling sick. Choice B is incorrect as injecting insulin in the same spot each time can lead to lipodystrophy. Choice D is incorrect as insulin injections are usually required based on meal schedules and blood glucose levels, not just when levels are above 200 mg/dL.

4. A nurse is preparing to administer packed RBCs to a client. Which of the following actions should the nurse take first?

• A. Prime the IV tubing with dextrose 5% in water
• B. Ensure the client's consent is on file
• C. Check the client's identification using two identifiers
• D. Administer the blood through a 22-gauge catheter

Correct answer: C

Rationale: The correct first action for the nurse to take when preparing to administer packed RBCs is to check the client's identification using two identifiers. This step is crucial to ensure that the right blood is given to the right client, preventing any transfusion errors. Priming the IV tubing with dextrose 5% in water and administering the blood through a 22-gauge catheter are important steps but should come after confirming the client's identity. Ensuring the client's consent is on file is also important but is not the immediate priority when preparing to administer packed RBCs.

5. If a nurse administers an incorrect dose of medication, which fact related to the incident report should the nurse document in the client's medical record?

• A. Time the medication was given
• B. The client's response to the medication
• C. The dose that was administered
• D. Reason for the error

Correct answer: A

Rationale: The correct answer is to document the time the medication was given. This is essential for understanding the sequence of events surrounding the medication error. While documenting the client's response to the medication (Choice B) is important for assessing any effects, the immediate concern should be to establish a clear timeline by documenting the time of administration. Recording the dose administered (Choice C) is also important, but in the context of understanding the incident, the time factor takes precedence. The reason for the error (Choice D) should be included in the incident report but may not be the first priority when documenting in the client's medical record.

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