Nursing Elites

1. A nurse is caring for a client who has chronic kidney disease and a serum potassium level of 6.5 mEq/L. Which of the following actions should the nurse take?

• A. Administer sodium bicarbonate
• B. Administer sodium polystyrene sulfonate
• C. Administer calcium gluconate
• D. Administer calcium carbonate

Correct answer: B

Rationale: The correct action for the nurse to take is to administer sodium polystyrene sulfonate. This medication promotes potassium excretion and helps lower serum potassium levels in clients with hyperkalemia, which is indicated by a high potassium level. Sodium bicarbonate (choice A) is not used to treat hyperkalemia. Calcium gluconate (choice C) and calcium carbonate (choice D) are used to manage hyperkalemia by stabilizing cell membranes but are not the initial treatment choice for lowering potassium levels.

2. A nurse is caring for a client who is receiving continuous enteral nutrition through a nasogastric tube. Which of the following actions should the nurse take?

• A. Administer the feeding using a large-bore syringe
• B. Check the placement of the tube every 8 hours
• C. Flush the tube with 5 mL of water every 6 hours
• D. Maintain the client in an upright position

Correct answer: B

Rationale: The correct action for the nurse to take is to check the placement of the nasogastric tube every 8 hours. This is crucial to ensure that the tube is correctly positioned in the stomach, reducing the risk of complications such as aspiration. Administering the feeding using a large-bore syringe (Choice A) is not recommended for enteral nutrition. Flushing the tube with water every 6 hours (Choice C) is not necessary for continuous enteral nutrition. Maintaining the client in an upright position (Choice D) is generally preferred to reduce the risk of aspiration, but it is not the most critical action compared to verifying tube placement.

3. A nurse is providing discharge teaching to a client who is recovering from a myocardial infarction. Which of the following client statements indicates a need for further teaching?

• A. I will take a daily aspirin to prevent another heart attack.
• B. I should expect to experience chest pain when I exercise.
• C. I will increase my intake of saturated fats.
• D. I will participate in a cardiac rehabilitation program.

Correct answer: C

Rationale: The correct answer is C. Increasing the intake of saturated fats can raise cholesterol levels, which is not recommended after a myocardial infarction. Choices A, B, and D are all appropriate statements indicating a good understanding of post-myocardial infarction care. Taking a daily aspirin can help prevent another heart attack, experiencing chest pain with exercise is a common expectation post-myocardial infarction, and participating in a cardiac rehabilitation program is important for recovery and improving heart health.

4. A client is receiving a new prescription for enoxaparin. Which of the following instructions should the nurse include?

• A. Rub the injection site after administration.
• B. Pinch the skin while administering the injection.
• C. Aspirate before administering the medication.
• D. Avoid taking aspirin while using this medication.

Correct answer: D

Rationale: The correct answer is D: 'Avoid taking aspirin while using this medication.' Enoxaparin is an anticoagulant medication, and taking aspirin concurrently can increase the risk of bleeding. Choices A, B, and C are incorrect. A nurse should not instruct the client to rub the injection site after administration as it may cause irritation. Pinching the skin while administering the injection is not recommended for enoxaparin injections. Aspirating before administering the medication is also unnecessary as enoxaparin is administered subcutaneously, not intramuscularly.

5. A nurse is assessing a client who is receiving furosemide for heart failure. Which of the following findings is the priority to report to the provider?

• A. Blood pressure of 98/58 mm Hg
• B. Urine output of 50 mL/hr
• C. Serum potassium level of 3.2 mEq/L
• D. Weight loss of 0.5 kg (1.1 lb) in 24 hours

Correct answer: C

Rationale: The correct answer is C. A serum potassium level of 3.2 mEq/L indicates hypokalemia, a potential complication of furosemide therapy, and should be reported immediately. Hypokalemia can lead to serious cardiac dysrhythmias. Choices A, B, and D are important assessments but are not as critical as managing serum potassium levels in a client receiving furosemide for heart failure.

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