Nursing Elites

1. A healthcare provider is planning care for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the healthcare provider include?

• A. Administer 0.9% sodium chloride with the TPN.
• B. Change the TPN tubing every 24 hours.
• C. Weigh the client every 72 hours.
• D. Flush the TPN line with heparin.

Correct answer: B

Rationale: The correct action the healthcare provider should include is changing the TPN tubing every 24 hours to decrease the risk of infection. Administering 0.9% sodium chloride with TPN is not typically recommended as it can cause chemical instability. Weighing the client every 72 hours is important but not directly related to TPN administration. Flushing the TPN line with heparin is not a standard practice and not recommended as it can increase the risk of complications.

2. A client has a central venous catheter. Which of the following actions should be taken to prevent an air embolism?

• A. Keep the catheter clamped when not in use
• B. Have the client perform the Valsalva maneuver while the catheter is removed
• C. Use a non-coring needle to access the catheter
• D. Flush the catheter with 0.9% sodium chloride every 24 hours

Correct answer: B

Rationale: The correct action to prevent an air embolism in a client with a central venous catheter is to have the client perform the Valsalva maneuver while the catheter is removed. This maneuver helps to close the airway and prevent air from entering the bloodstream. Keeping the catheter clamped at all times (Choice A) is not necessary and may lead to clot formation. Using a non-coring needle (Choice C) is important for accessing the catheter but does not specifically prevent air embolism. Flushing the catheter with 0.9% sodium chloride (Choice D) helps maintain patency but does not directly prevent air embolism.

3. A client with a history of heart failure is receiving furosemide. Which of the following laboratory values should the nurse monitor?

• A. Sodium 140 mEq/L
• B. Calcium 9.0 mg/dL
• C. Potassium 3.2 mEq/L
• D. Chloride 100 mEq/L

Correct answer: C

Rationale: The correct answer is C: Potassium 3.2 mEq/L. A potassium level of 3.2 mEq/L is below the normal range and should be monitored in clients receiving furosemide due to the risk of hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion, leading to hypokalemia. Monitoring potassium levels is crucial to prevent complications such as cardiac arrhythmias. Choices A, B, and D are not directly impacted by furosemide therapy in the same way as potassium levels, making them less relevant for monitoring in this scenario.

4. A client has a new diagnosis of COPD. Which of the following instructions should the nurse include in the teaching?

• A. Breathe rapidly through your mouth when using the incentive spirometer.
• B. Use pursed-lip breathing during periods of dyspnea.
• C. Avoid drinking fluids during meals.
• D. Use diaphragmatic breathing during periods of dyspnea.

Correct answer: B

Rationale: Pursed-lip breathing is a beneficial technique for clients with COPD as it helps control shortness of breath and improves oxygenation. This technique involves inhaling slowly through the nose and exhaling through pursed lips, which helps keep airways open. Option A is incorrect as breathing rapidly through the mouth when using the incentive spirometer can lead to hyperventilation. Option C is incorrect because it is important for clients with COPD to stay hydrated by drinking fluids between meals, but not during meals which can cause bloating and discomfort. Option D is incorrect as diaphragmatic breathing, though beneficial, is not the preferred technique for managing dyspnea in COPD; pursed-lip breathing is more effective.

5. A nurse is caring for a client who is receiving continuous cardiac monitoring. The client's heart rate is 69/min, and the PR interval is 0.24 seconds. What cardiac rhythm should the nurse interpret this finding as?

• A. First-degree AV block.
• B. Premature ventricular contraction.
• C. Sinus bradycardia.
• D. Atrial fibrillation.

Correct answer: A

Rationale: The correct answer is A: First-degree AV block. A PR interval of 0.24 seconds indicates a prolonged PR interval, which is characteristic of first-degree AV block. This rhythm is considered benign and often does not require treatment. Choice B, premature ventricular contraction, is characterized by early, abnormal ventricular contractions and would not be indicated by the findings provided. Choice C, sinus bradycardia, would present with a normal PR interval but a heart rate less than 60 beats per minute. Choice D, atrial fibrillation, is characterized by an irregularly irregular rhythm with no identifiable P waves, which does not align with the findings of a prolonged PR interval in this scenario.

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