Nursing Elites

1. When caring for a client with acute renal failure, which laboratory value is most important to monitor?

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

Correct answer: B

Rationale: In acute renal failure, monitoring serum potassium is crucial because impaired kidney function can lead to hyperkalemia, which can result in life-threatening cardiac dysrhythmias. Elevated potassium levels need close monitoring and prompt interventions to prevent serious complications.

2. When admitting a client with active tuberculosis to a room on a medical-surgical unit, which of the following room assignments should the nurse make?

• A. A room with air exhaust directly to the outdoor environment
• B. A room with another nonsurgical client
• C. A room in the ICU
• D. A room that is within view of the nurses' station

Correct answer: A

Rationale: When admitting a client with active tuberculosis, it is crucial to assign them to a room with air exhaust directly to the outdoor environment to prevent the spread of infectious particles to other patients and healthcare workers. This setup helps in reducing the risk of transmission within the healthcare facility. Placing the client in a room with another nonsurgical client or in the ICU may increase the chances of spreading the infection. Additionally, placing the client in a room within view of the nurses' station does not address the need for proper ventilation to minimize transmission of tuberculosis.

3. During a call to the on-call physician about a client who had a hysterectomy 2 days ago & has unrelieved pain from prescribed narcotic medication, which statement is part of the SBAR format for communication?

• A. I suggest ordering a different pain medication.
• B. This client has allergies to morphine & codeine.
• C. Dr. Smith does not prefer nonsteroidal anti-inflammatory meds.
• D. The client had a vaginal hysterectomy 2 days ago.

Correct answer: B

Rationale: SBAR is a structured form of communication used in healthcare settings. It stands for Situation, Background, Assessment, and Recommendation. In this scenario, informing the on-call physician about the client's allergies to morphine & codeine falls under the 'Background' component of the SBAR format, making choice B the correct answer.

4. A client in an emergency department has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?

• A. Raise the foot of the bed to a 90� angle
• B. Remove the dressing to inspect the wound
• C. Prepare to insert a central line
• D. Administer oxygen via nasal cannula

Correct answer: D

Rationale: In a client with a sucking chest wound, the priority is to administer oxygen via nasal cannula to improve oxygenation. The client's blood pressure, weak pulse rate, and elevated respiratory rate indicate hypovolemic shock, so increasing oxygen supply is crucial. Raising the foot of the bed, removing the dressing, or preparing to insert a central line are not immediate actions needed for a client with a sucking chest wound and signs of shock.

5. A client is receiving discharge teaching after a total hip replacement. Which statement by the client indicates a need for further teaching?

• A. I will avoid crossing my legs when sitting.
• B. I can sleep on my side as long as I use a pillow between my legs.
• C. I will avoid bending at the waist to pick things up.
• D. I can bend down to tie my shoes after 2 weeks.

Correct answer: D

Rationale: After a total hip replacement, clients should avoid bending at the waist past 90 degrees for at least 6 weeks to prevent dislocation of the hip prosthesis. Bending down to tie shoes involves significant hip flexion and should be avoided during the initial postoperative period to ensure proper healing and reduce the risk of complications.

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