Nursing Elites

1. A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury (AKI). Which of the following findings should the nurse identify as indicating an increased risk of AKI?

• A. Magnesium 2.0 mEq/L
• B. Blood urea nitrogen (BUN) 20 mg/dL
• C. Serum Osmolality 290 mOsm/kg H2O
• D. Serum creatinine 1.8 mg/dL

Correct answer: D

Rationale: An elevated serum creatinine level (1.8 mg/dL) is a significant indicator of potential kidney impairment. In acute kidney injury (AKI), serum creatinine levels rise due to decreased kidney function, reflecting the kidneys' inability to effectively filter waste from the blood. Magnesium level, BUN, and serum osmolality are not direct indicators of kidney function or risk of AKI. Magnesium levels are more related to electrolyte balance, BUN can be affected by factors other than kidney function, and serum osmolality reflects the concentration of solutes in the blood, not specifically kidney function.

2. In a disaster where a building has collapsed, which victim should a nurse attend to first?

• A. A victim who has died of multiple serious injuries
• B. A victim with a partial amputation of a leg who is bleeding profusely
• C. An alert victim who has numerous bruises on the arms and legs
• D. A hysterical victim who has sustained a head injury

Correct answer: B

Rationale: In a disaster situation like a building collapse, the nurse should attend to the victim with a partial amputation of a leg who is bleeding profusely first. This victim is at immediate risk of severe blood loss, which can be life-threatening. It is crucial to address life-threatening injuries like severe bleeding before attending to other less urgent cases. The victim with the amputation requires immediate intervention to control bleeding and stabilize their condition. Victims who are already deceased or have less urgent injuries can be attended to after addressing the critical cases.

3. A nurse is completing an assessment of a recently widowed older adult client. He states he is unable to drive and is afraid to cook on the stove. Which of the following community resources should the nurse recommend?

• A. Hospice care
• B. Meals on Wheels
• C. Home health services
• D. American Association of Retired Persons

Correct answer: B

Rationale: The correct answer is B: Meals on Wheels. Meals on Wheels is a community resource that provides food for older adults who are unable to cook for themselves, promoting independence and ensuring proper nutrition. Hospice care (choice A) focuses on providing comfort and support for individuals with life-limiting illnesses; it is not primarily aimed at providing meals. Home health services (choice C) typically involve skilled nursing care and therapy services provided in the home setting, rather than meal delivery. The American Association of Retired Persons (choice D) offers advocacy, support, and resources for older adults but does not directly address the specific needs mentioned in the client's situation.

4. A family was referred to crisis intervention services after a natural disaster. One family member refuses to attend, stating, 'No way, I'm not crazy.' What is the nurse's best response?

• A. Don't worry now. The psychiatrists are well trained to help.
• B. Many times, disasters can create mental health problems, so you really should participate with your family.
• C. This will help your family communicate better.
• D. Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique.

Correct answer: D

Rationale: The nurse should reassure the family member that seeking help does not imply mental illness, but is part of coping with the disaster.

5. A client requires suctioning every 2 hours. To whom should the nurse delegate this task?

• A. Delegate to a licensed practical nurse (LPN)
• B. Delegate to a registered nurse (RN)
• C. Delegate to a nursing assistant (NA)
• D. Perform the task independently

Correct answer: A

Rationale: The correct answer is to delegate the task to a licensed practical nurse (LPN). LPNs can typically perform suctioning, but it is essential to consider the state's practice guidelines and hospital policy. Option B, delegating to a registered nurse (RN), is not necessary for this task as LPNs are usually competent to handle suctioning. Option C, delegating to a nursing assistant (NA), may not be appropriate as suctioning may require a higher level of training and expertise. Option D, performing the task independently, is not the best choice as delegation is a key aspect of nursing practice to ensure tasks are appropriately assigned based on competency levels.

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