Nursing Elites

1. A client has a nasogastric tube for gastric decompression. Which of the following actions should the nurse take?

• A. Check for the presence of bowel sounds every 8 hours.
• B. Flush the NG tube every 24 hours.
• C. Provide the client with sips of water every 2 hours.
• D. Keep the client's head of the bed elevated to 45 degrees.

Correct answer: D

Rationale: The correct answer is to keep the client's head of the bed elevated to 45 degrees. This position helps prevent aspiration in clients with a nasogastric tube for gastric decompression by reducing the risk of reflux and promoting proper drainage. Choice A is incorrect because checking for bowel sounds is not directly related to the care of a nasogastric tube. Choice B is incorrect as flushing the NG tube every 24 hours is not a standard nursing practice and may lead to complications. Choice C is incorrect because providing sips of water may interfere with the purpose of gastric decompression, which is to keep the stomach empty.

2. A nurse in the emergency department is caring for a client who reports intimate partner violence. Which of the following interventions is the nurse's priority?

• A. Develop a safety plan with the client.
• B. Refer the client to a community support group.
• C. Determine if the client has any injuries.
• D. Contact the client's family about the incident.

Correct answer: A

Rationale: The correct answer is to develop a safety plan with the client. In cases of intimate partner violence, the priority is to ensure the client's immediate safety. While referring the client to a community support group (choice B) and determining if the client has any injuries (choice C) are important interventions, ensuring the client's safety through a safety plan takes precedence. Contacting the client's family about the incident (choice D) may not be appropriate as it can further endanger the client.

3. A nurse is reviewing laboratory data for a client who has chronic kidney disease. Which of the following findings should the nurse expect?

• A. Increased creatinine
• B. Increased hemoglobin
• C. Increased bicarbonate
• D. Increased calcium

Correct answer: A

Rationale: The correct answer is A: Increased creatinine. In chronic kidney disease, the kidneys are unable to filter waste effectively, leading to a buildup of creatinine in the blood. This results in increased creatinine levels in laboratory tests. Choice B, increased hemoglobin, is not typically associated with chronic kidney disease. Choice C, increased bicarbonate, is also not a common finding in chronic kidney disease; in fact, metabolic acidosis with decreased bicarbonate levels is more common. Choice D, increased calcium, is not expected in chronic kidney disease; instead, calcium levels may be low due to impaired kidney function.

4. What lab value should a healthcare provider monitor for a patient on warfarin therapy?

• A. Potassium
• B. PT/INR
• C. Sodium
• D. Calcium

Correct answer: B

Rationale: The correct answer is B: PT/INR. When a patient is on warfarin therapy, healthcare providers monitor the PT/INR levels to evaluate the effectiveness of the treatment and assess the risk of bleeding. Monitoring potassium, sodium, or calcium levels is not directly related to warfarin therapy and would not provide the necessary information needed to manage the medication effectively.

5. A client is at risk for developing deep vein thrombosis (DVT). Which of the following actions should the nurse take?

• A. Encourage the client to remain on bed rest.
• B. Massage the client's legs every 4 hours.
• C. Apply sequential compression devices to the client's legs.
• D. Administer anticoagulants as prescribed.

Correct answer: C

Rationale: The correct action the nurse should take for a client at risk for developing DVT is to apply sequential compression devices to the client's legs. This intervention helps prevent venous stasis by promoting circulation and reducing the risk of DVT. Encouraging the client to remain on bed rest (Choice A) can actually increase the risk of DVT due to immobility. Massaging the client's legs every 4 hours (Choice B) can dislodge blood clots and is contraindicated in DVT prevention. While administering anticoagulants as prescribed (Choice D) is a treatment for DVT, it is not a preventive measure for a client at risk.

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