Nursing Elites

1. A nurse is caring for a client who is receiving furosemide. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the medication?

• A. Serum sodium.
• B. Serum glucose.
• C. Serum potassium.
• D. Serum calcium.

Correct answer: C

Rationale: The correct answer is C: Serum potassium. Furosemide is a potassium-wasting diuretic, meaning it can lead to potassium loss in the body. Monitoring serum potassium levels is crucial to evaluate the effectiveness of furosemide and prevent hypokalemia. Options A, B, and D are incorrect because furosemide does not directly affect sodium, glucose, or calcium levels in the same way it impacts potassium levels.

2. During an emergency response following a disaster, which client should be recommended for early discharge?

• A. A client with COPD and a respiratory rate of 44/min.
• B. A client with cancer and a sealed implant for radiation therapy.
• C. A client receiving heparin for deep-vein thrombosis.
• D. A client who is 1 day postoperative following a vertebroplasty.

Correct answer: D

Rationale: The client who is 1 day postoperative following a vertebroplasty is stable and can be discharged early. In an emergency response situation, it is crucial to prioritize clients who are medically stable and do not require immediate hospital care. The client with COPD and a respiratory rate of 44/min needs close monitoring and intervention. The client with cancer and a sealed implant for radiation therapy requires specialized care and follow-up. The client receiving heparin for deep-vein thrombosis needs ongoing anticoagulant therapy and monitoring, making early discharge not appropriate.

3. A nurse is assessing a client who is 1 day postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?

• A. Blood pressure of 110/70 mm Hg
• B. Heart rate of 88/min
• C. Respiratory rate of 20/min
• D. Temperature of 37.3°C (99.1°F)

Correct answer: D

Rationale: The correct answer is D because a temperature of 37.3°C (99.1°F) is slightly elevated, indicating a possible infection or inflammatory response, which should be reported to the provider for further evaluation. Choices A, B, and C are within normal limits for a client postoperative, so they do not require immediate reporting. Elevated temperature can be a sign of infection or other complications, making it a priority for reporting and further assessment.

4. A charge nurse is teaching a newly licensed nurse about clients designating a health care proxy. Which of the following information should the charge nurse include?

• A. The proxy should make health care decisions for the client regardless of the client's ability to do so
• B. The proxy can make financial decisions if the need arises
• C. The proxy can make treatment decisions if the client is under anesthesia
• D. The proxy should manage legal issues for the client

Correct answer: C

Rationale: The correct answer is C because the health care proxy can make treatment decisions for the client if the client is under anesthesia. This aligns with the concept of durable power of attorney for health care, where the proxy is authorized to make health care decisions when the client is unable to do so. Choices A, B, and D are incorrect. Choice A is incorrect because the proxy should make health care decisions only when the client is unable to do so. Choice B is incorrect as financial decisions are not typically within the scope of a health care proxy. Choice D is incorrect as managing legal issues is not the primary role of a health care proxy.

5. A nurse is planning care for a client with thrombocytopenia. Which action should the nurse include?

• A. Encourage the client to floss daily.
• B. Remove fresh flowers from the client's room.
• C. Provide the client with a stool softener.
• D. Avoid serving raw vegetables.

Correct answer: C

Rationale: The correct action the nurse should include for a client with thrombocytopenia is to provide a stool softener. Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. Providing a stool softener helps prevent constipation, straining, and subsequent bleeding, which is crucial for clients with thrombocytopenia. Encouraging the client to floss daily (Choice A) is important for oral hygiene but not directly related to thrombocytopenia. Removing fresh flowers from the client's room (Choice B) is more related to infection control than managing thrombocytopenia. Avoiding serving raw vegetables (Choice D) is important for clients with compromised immune systems to reduce the risk of foodborne illnesses but is not directly related to thrombocytopenia management.

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