Nursing Elites

1. A nurse is planning care for a client who has hypernatremia. Which of the following actions should the nurse include in the plan of care?

• A. Infuse hypotonic IV fluids.
• B. Implement a fluid restriction.
• C. Increase sodium intake.
• D. Administer sodium polystyrene sulfonate.

Correct answer: A

Rationale: The correct answer is to infuse hypotonic IV fluids. In hypernatremia, there is an elevated sodium concentration in the blood, and diluting it with hypotonic fluids helps to lower the sodium levels. Implementing a fluid restriction or increasing sodium intake would worsen hypernatremia by further concentrating sodium in the body. Administering sodium polystyrene sulfonate is used for treating hyperkalemia, not hypernatremia.

2. When providing hygiene for an older-adult patient, why does the nurse closely assess the skin?

• A. Outer skin layer becomes less resilient.
• B. Less frequent bathing may be required.
• C. Skin becomes more subject to bruising.
• D. Sweat glands become less active.

Correct answer: B

Rationale: The correct answer is B: 'Less frequent bathing may be required.' In older adults, daily bathing or using hot water and harsh soap can lead to excessively dry skin. Therefore, the nurse closely assesses the skin to determine if less frequent bathing is necessary to prevent skin dryness and maintain skin integrity. Choice A is incorrect because the outer skin layer does not become less resilient with age. Choice C is incorrect as aging skin is actually more prone to bruising due to thinning of the skin. Choice D is incorrect because sweat gland activity generally decreases with age, leading to reduced skin moisture rather than increased activity.

3. A nurse at a provider’s office is discussing routine screenings with a 45-year-old female client who has no specific family history of cancer or diabetes mellitus. Which of the following client statements indicates that the client understands how to proceed?

• A. “So I don’t need the colon cancer screening for another 2 or 3 years.”
• B. “For now, I should continue to have a mammogram each year.”
• C. “Because the doctor just performed a Pap smear, I’ll return next year for another one.”
• D. “I had my glucose test last year, so I won’t need it again for 4 years.”

Correct answer: B

Rationale: The correct answer is B. Mammograms are recommended annually for women starting at age 40 or 45. This statement aligns with current guidelines for breast cancer screening in women without specific risk factors. Choice A is incorrect because colon cancer screenings are typically recommended at different intervals. Choice C is incorrect as Pap smears are usually done every 3-5 years based on age and risk factors. Choice D is incorrect because glucose testing is usually recommended more frequently, especially for individuals at risk for diabetes mellitus.

4. When changing the client's dressing, which observation should the nurse report to the client's surgeon for a client recovering from an appendectomy for a ruptured appendix with a surgical wound healing by secondary intention?

• A. A halo of erythema on the surrounding skin
• B. Presence of serous drainage
• C. Edema around the wound
• D. Absence of granulation tissue

Correct answer: A

Rationale: A halo of erythema on the surrounding skin may indicate an infection or inflammation of the wound site, which is critical to report to the surgeon. Erythema, redness, and warmth are signs of inflammation that could potentially be a sign of an infected wound. Serous drainage is a common and expected finding in healing wounds, indicating a normal healing process. Edema around the wound might be expected due to the body's response to tissue injury. The absence of granulation tissue in a wound healing by secondary intention may not be an immediate concern as it forms during the later stages of wound healing.

5. When taking a history of a 3-year-old with neuroblastoma, what comment by the parents requires follow-up and is consistent with the diagnosis?

• A. The child has been listless and has lost weight.
• B. The urine is dark yellow and in small amounts.
• C. Clothes are becoming tighter across her abdomen.
• D. We notice muscle weakness and some unsteadiness.

Correct answer: C

Rationale: The correct answer is C. Clothes becoming tighter across the abdomen is indicative of an abdominal mass, a common presentation in neuroblastoma. This symptom should be followed up on further as it aligns with the diagnosis. Choices A, B, and D are less specific to neuroblastoma. Weight loss and listlessness (Choice A) can be nonspecific symptoms, while dark yellow urine in small amounts (Choice B) may suggest dehydration or other conditions. Muscle weakness and unsteadiness (Choice D) could point towards various neurological or muscular issues but are not as directly related to neuroblastoma as the symptom described in Choice C.

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