Nursing Elites

1. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

• A. Monitor the client's temperature every 4 hours
• B. Monitor blood glucose levels every 6 hours
• C. Administer insulin as prescribed
• D. Monitor daily fluid intake

Correct answer: B

Rationale: Corrected Rationale: Monitoring blood glucose levels is crucial in clients receiving TPN because the solution has a high glucose content. This monitoring helps prevent hyperglycemia and allows for timely adjustments in the TPN formulation if needed. Monitoring the client's temperature (Choice A) is not directly related to TPN administration. Administering insulin (Choice C) should be based on blood glucose levels and the healthcare provider's orders; it is not a standard intervention for all clients on TPN. Monitoring daily fluid intake (Choice D) is important for overall fluid balance but is not as critical as monitoring blood glucose levels specifically for clients on TPN.

2. A client has a prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include in the teaching?

• A. Place the tablet under the tongue and wait 10 minutes
• B. Take up to five tablets during an angina episode
• C. Take up to three tablets during a single angina episode
• D. Swallow the tablet with water

Correct answer: C

Rationale: The correct answer is C: 'Take up to three tablets during a single angina episode.' Nitroglycerin can be taken up to three times during an episode to relieve angina. Choice A is incorrect because the client should place the tablet under the tongue and wait for it to dissolve, not wait for 10 minutes. Choice B is incorrect because taking up to five tablets during an angina episode is excessive and not recommended. Choice D is incorrect because nitroglycerin tablets are meant to be taken sublingually, not swallowed.

3. A client has a history of oliguria, hypertension, and peripheral edema. Current lab values are: BUN - 25, K+ - 4.0 mEq/L. Which nutrient should be restricted in the client's diet?

• A. Protein
• B. Fats
• C. Carbohydrates
• D. Magnesium

Correct answer: A

Rationale: In clients with oliguria, hypertension, and peripheral edema, protein should be restricted in the diet to reduce the workload on the kidneys. Excessive protein intake can lead to increased BUN levels, which can further stress the kidneys. Restricting protein can help prevent further kidney damage. Fats, carbohydrates, and magnesium do not directly impact kidney function in the same way as protein does, making them incorrect choices in this scenario.

4. What is the correct procedure for inserting a nasogastric (NG) tube?

• A. Measure the tube and insert with lubrication
• B. Insert with lubrication and no measurement
• C. Insert without lubrication and secure it
• D. Insert with lubrication and check placement

Correct answer: A

Rationale: The correct procedure for inserting a nasogastric (NG) tube involves measuring the tube to ensure the appropriate length for insertion and using lubrication to reduce discomfort and aid in smooth insertion. Choice B is incorrect as measuring the tube is essential for proper placement. Choice C is incorrect as lubrication helps in easing the insertion process. Choice D is incorrect as checking the placement comes after insertion and should not be done simultaneously with the insertion process.

5. A client with a serum albumin level of 3 g/dL has a pressure ulcer. What should the nurse do first?

• A. Monitor the client's fluid and electrolyte balance
• B. Consult a dietitian to improve the client's nutritional status
• C. Administer a protein supplement
• D. Administer an anti-inflammatory medication

Correct answer: B

Rationale: The correct first action for a client with a serum albumin level of 3 g/dL and a pressure ulcer is to consult a dietitian to improve the client's nutritional status. Adequate nutrition is essential for wound healing. Monitoring fluid and electrolyte balance is important but not the first priority in this situation. Administering a protein supplement can be considered after dietary evaluation. Administering an anti-inflammatory medication is not the primary intervention for addressing a pressure ulcer related to low albumin levels.

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