Nursing Elites

1. A nurse is caring for a client who has the following laboratory results: potassium 3.4 mEq/L, magnesium 1.8 mEq/L, calcium 8.5 mEq/L, sodium 144 mEq/L. Which assessment should the nurse complete first?

• A. Assess the client's dietary intake of foods high in potassium.
• B. Assess the client's neuromuscular status.
• C. Assess the client's fluid intake and output.
• D. Read food labels to determine sodium content.

Correct answer: D

Rationale: The correct answer is to read food labels to determine sodium content. The client's sodium level is crucial to monitor as it is on the higher side (144 mEq/L), which can indicate hypernatremia. Excessive sodium intake can lead to fluid retention and other complications. Assessing dietary sodium intake can help the nurse and client make necessary adjustments to prevent further sodium imbalances. Choices A, B, and C are not the priority in this situation as the client's sodium level needs immediate attention to prevent potential complications.

2. What fluid is found in spaces between the cells?

• A. Intracellular fluid
• B. Interstitial fluid
• C. Plasma
• D. Electrolyte

Correct answer: B

Rationale: The correct answer is B, Interstitial fluid. Interstitial fluid is the fluid that surrounds and occupies the spaces between cells, providing them with nutrients and removing waste. Choices A, C, and D are incorrect because intracellular fluid refers to fluid inside cells, plasma refers to the liquid component of blood, and electrolyte refers to substances that dissociate into ions in solution, affecting fluid balance but not specifically found in spaces between cells.

3. A nurse is caring for a client who is having a subclavian central venous catheter inserted. The client begins to report chest pain and difficulty breathing. After administering oxygen, which action should the nurse take next?

• A. Administer a sublingual nitroglycerin tablet
• B. Prepare to assist with chest tube insertion.
• C. . Place a sterile dressing over the IV site
• D. Re-position the client into the Trendelenburg position.

Correct answer: B

Rationale:

4. Your patient has alcoholism, and you may suspect during your assessment that his serum magnesium is low. What will the nurse potentially expect to assess related to hypomagnesemia?

• A. Tremor
• B. Pruritus
• C. Edema
• D. Decreased blood pressure

Correct answer: A

Rationale: The correct answer is A: Tremor. Signs and symptoms of hypomagnesemia primarily affect the neuromuscular system and can include tremors, confusion, tetany, laryngeal stridor, and ataxia. Pruritus (choice B) refers to itching and is not typically associated with hypomagnesemia. Edema (choice C) is swelling caused by fluid retention and is not a common manifestation of hypomagnesemia. Decreased blood pressure (choice D) is not a typical sign of hypomagnesemia; instead, low magnesium levels are more likely to cause hypertension.

5. Which of the following are sources of water intake?

• A. Drinking fluids.
• B. Consuming water from the food we eat.
• C. Water from metabolic processes.
• D. Drinking fluids, consuming water from the food we eat, and water from metabolic processes.

Correct answer: D

Rationale: The correct answer is D. The sources of water intake include drinking fluids, consuming water from the food we eat, and water from metabolic processes. Water intake is not solely from the liquids we drink but also from the water content present in the food we consume and the water produced during metabolic processes such as cellular respiration. Therefore, option D is the correct answer as it covers all the sources of water intake. Options A, B, and C alone do not encompass all the sources of water intake, making them incorrect choices.

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