Nursing Elites

1. A nurse is caring for a client who has a prescription for enoxaparin. Which of the following actions should the nurse take?

• A. Inject the medication into the deltoid muscle
• B. Inject the medication deep into subcutaneous tissue
• C. Massage the injection site for 2 minutes after administration
• D. Insert the needle at a 10-degree angle

Correct answer: B

Rationale: The correct action the nurse should take when administering enoxaparin is to inject the medication deep into subcutaneous tissue. This method helps ensure proper absorption of the medication and prevents tissue irritation. Injecting into the deltoid muscle (Choice A) is not recommended for enoxaparin administration. Massaging the injection site (Choice C) can lead to tissue damage and bruising. Inserting the needle at a 10-degree angle (Choice D) is not the correct technique for administering enoxaparin.

2. A client with a new diagnosis of hypertension is being taught by a nurse. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should avoid eating foods high in potassium.
• B. I will check my blood pressure at least once a week.
• C. I should increase my intake of dairy products.
• D. I should exercise for 30 minutes at least 5 days a week.

Correct answer: D

Rationale: The correct answer is D. Exercising for 30 minutes at least 5 days a week helps manage hypertension by promoting cardiovascular health. Statements A, B, and C are incorrect. Avoiding foods high in potassium is not necessary unless specifically advised by a healthcare provider. Checking blood pressure once a week is not frequent enough for effective monitoring. Increasing dairy product intake is not a recommended approach to managing hypertension.

3. A nurse is caring for a client who is receiving total parenteral nutrition. Which of the following laboratory findings should the nurse report to the provider?

• A. Prealbumin level of 20 mg/dL
• B. Serum albumin level of 3.5 g/dL
• C. Serum sodium level of 138 mEq/L
• D. Blood glucose level of 120 mg/dL

Correct answer: D

Rationale: The correct answer is D because a blood glucose level of 120 mg/dL falls within the normal range. A low serum albumin level, as mentioned in choice B, should be reported as it may indicate malnutrition. Choices A and C are within normal ranges and would not typically require immediate reporting.

4. A nurse is reviewing the medical records of a client with a history of depression who is experiencing a situational crisis. What should the nurse do first?

• A. Confirm the client's perception of the event.
• B. Notify the client's support system.
• C. Help the client identify personal strengths.
• D. Teach the client relaxation techniques.

Correct answer: A

Rationale: Confirming the client's perception of the event is crucial in understanding how they are interpreting the crisis situation. This helps the nurse gain insight into the client's perspective, emotions, and needs. By validating the client's perception, the nurse can establish trust and rapport, which are essential in providing effective support during a crisis. Notifying the client's support system (Choice B) may be important but should come after understanding the client's perspective. Helping the client identify personal strengths (Choice C) and teaching relaxation techniques (Choice D) are valuable interventions but should follow the initial step of confirming the client's perception to ensure individualized care.

5. A nurse is reviewing the laboratory results of a client who has hypocalcemia. Which of the following findings should the nurse expect?

• A. Positive Trousseau's sign
• B. Increased deep tendon reflexes
• C. Hyperactive bowel sounds
• D. Weak, thready pulse

Correct answer: A

Rationale: A positive Trousseau's sign is a key finding in clients with hypocalcemia, indicating neuromuscular irritability. The other choices are not typically associated with hypocalcemia. Increased deep tendon reflexes are more indicative of hypercalcemia. Hyperactive bowel sounds can be seen in hyperactive bowel conditions or diarrhea, not specifically related to hypocalcemia. A weak, thready pulse may indicate cardiovascular issues, such as dehydration, but it is not a typical finding in hypocalcemia.

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