Nursing Elites

1. A healthcare professional is monitoring the respiratory status of a client who has just undergone surgery and is wearing a pulse oximeter. Which of the following coexisting problems is cause for the healthcare professional to suspect that the oxygen saturation readings are not entirely accurate?

• A. Infection
• B. Hypertension
• C. Low blood pressure
• D. Loss of cough reflex

Correct answer: C

Rationale: Low blood pressure (hypotension), shock, and the use of peripheral vasoconstricting medications can lead to inaccurate pulse oximetry readings due to impaired peripheral perfusion. Hypertension and infection are not typically associated with inaccurate pulse oximetry readings, while the loss of cough reflex does not directly affect oxygen saturation readings.

2. A client is scheduled to undergo computerized tomography (CT) with contrast for evaluation of an abdominal mass. The nurse should tell the client that:

• A. The test may be painful
• B. The test takes 2 to 3 hours
• C. Food and fluids are not allowed for 4 hours after the test
• D. Dye is injected and may cause a warm flushing sensation

Correct answer: D

Rationale: The correct answer is D. A contrast-aided CT scan involves the injection of dye to enhance the images obtained. The dye may cause a warm flushing sensation when injected, which is a common side effect. Choices A, B, and C are incorrect. CT with contrast is generally not a painful procedure, the duration of the test does not usually take 2 to 3 hours, and restrictions on food and fluids are typically before the test, not afterward.

3. A client with cardiovascular disease is scheduled to receive a daily dose of furosemide (Lasix). Which potassium level would cause the nurse to contact the physician before administering the dose?

• A. 3.0 mEq/L
• B. 3.8 mEq/L
• C. 4.2 mEq/L
• D. 5.1 mEq/L

Correct answer: A

Rationale: The normal serum potassium level in adults ranges from 3.5 to 5.1 mEq/L. A potassium level of 3.0 mEq/L is low, indicating hypokalemia and necessitating physician notification before administering furosemide, a loop diuretic that can further lower potassium levels. Potassium levels of 3.8 and 4.2 mEq/L are within the normal range, while a level of 5.1 mEq/L is high (hyperkalemia), but the critical value in this case is the low potassium level that requires immediate attention to prevent potential complications.

4. A client is getting out of bed for the first time since surgery. The client complains of dizziness after the nurse raises the head of the bed. Which of the following actions should the nurse take first?

• A. Checking the client’s blood pressure
• B. Checking the oxygen saturation level
• C. Having the client take some deep breaths
• D. Lowering the head of the bed slowly until the dizziness is relieved

Correct answer: D

Rationale: When a client experiences dizziness after being positioned upright for the first time post-surgery, the initial action the nurse should take is to lower the head of the bed slowly until the dizziness subsides. This maneuver helps alleviate the dizziness by allowing the body to adapt gradually to the change in position. Subsequently, the nurse should assess the client's pulse and blood pressure. Checking the blood pressure is essential to evaluate the circulatory status and rule out orthostatic hypotension as a cause of dizziness. Checking the oxygen saturation level and having the client take deep breaths are not the priority in this scenario as the primary concern is addressing the circulatory issue causing dizziness, not a respiratory problem.

5. Which of the following lab results is most indicative of dehydration?

• A. Low sodium levels.
• B. Elevated creatinine levels.
• C. Low potassium levels.
• D. High blood glucose levels.

Correct answer: B

Rationale: Elevated creatinine levels are indicative of dehydration because when the body is dehydrated, the kidneys concentrate urine to preserve fluid, leading to higher levels of creatinine. Low sodium levels (Choice A) can be seen in conditions like hyponatremia but are not specific to dehydration. Low potassium levels (Choice C) are more commonly associated with conditions like hypokalemia. High blood glucose levels (Choice D) are typically seen in diabetes and are not specific indicators of dehydration.

Similar Questions