Nursing Elites

1. A nurse is preparing to mix NPH and regular insulin in the same syringe. Which of the following actions should the nurse take?

• A. Inject air into the NPH insulin vial.
• B. Withdraw the prescribed dose of regular insulin.
• C. Withdraw the prescribed dose of NPH insulin.
• D. Mix the two insulins in separate syringes.

Correct answer: A

Rationale: When mixing NPH and regular insulin in the same syringe, the nurse should first inject air into the NPH insulin vial. This action prevents contamination by allowing an easier withdrawal of the correct dose of NPH insulin after withdrawing the regular insulin. Withdrawing the prescribed dose of regular insulin (Choice B) is incorrect as it does not address the initial step of injecting air into the NPH vial. Similarly, withdrawing the prescribed dose of NPH insulin (Choice C) is incorrect as it skips the crucial first step. Mixing the two insulins in separate syringes (Choice D) is not ideal since combining them in one syringe is a common practice to reduce the number of injections for the patient.

2. A nurse is providing dietary teaching to a client with irritable bowel syndrome. Which of the following recommendations should the nurse include?

• A. Consume foods high in bran fiber.
• B. Increase intake of milk products.
• C. Sweeten foods with fructose corn syrup.
• D. Increase intake of foods high in gluten.

Correct answer: A

Rationale: The correct answer is A: Consume foods high in bran fiber. Bran fiber helps alleviate symptoms of irritable bowel syndrome by promoting regular bowel movements. Choice B is incorrect as increasing intake of milk products may exacerbate symptoms in some individuals with irritable bowel syndrome who are lactose intolerant. Choice C is incorrect as fructose corn syrup may worsen symptoms due to its high fructose content, which can be poorly absorbed in some individuals with irritable bowel syndrome. Choice D is incorrect as increasing foods high in gluten may be problematic for individuals with irritable bowel syndrome who have gluten sensitivity or celiac disease.

3. A healthcare provider is reviewing the laboratory report of a client with a prescription for digoxin. Which result requires withholding the medication?

• A. Digoxin 0.8 ng/mL
• B. Sodium 145 mEq/L
• C. BUN 20 mg/dL
• D. Potassium 3.1 mEq/L

Correct answer: D

Rationale: The correct answer is D. A low potassium level (3.1 mEq/L) can increase the risk of digoxin toxicity. Hypokalemia can potentiate the effects of digoxin on the heart, leading to serious dysrhythmias. Choices A, B, and C are within normal ranges and do not indicate a need to withhold digoxin.

4. When discussing clients designating a health care proxy in situations requiring a durable power of attorney for health care (DPAHC), what information should the charge nurse include?

• A. The proxy should make health care decisions for the client regardless of the client's ability to do so.
• B. The proxy can make financial decisions if the need arises.
• C. The proxy can make treatment decisions if the client is under anesthesia.
• D. The proxy should manage legal issues for the client.

Correct answer: C

Rationale: The correct answer is C. The charge nurse should include information that the proxy can make treatment decisions if the client is under anesthesia. This is a key function of a durable power of attorney for health care. Choices A, B, and D are incorrect because a health care proxy's role is specifically related to making health care decisions, not financial decisions, legal issues, or decisions made under anesthesia.

5. A nurse is assessing a client who is 2 days postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?

• A. Serosanguineous drainage on the dressing
• B. Heart rate of 88/min
• C. Urine output of 30 mL/hr
• D. Blood pressure of 110/70 mm Hg

Correct answer: C

Rationale: The correct answer is C because a urine output of 30 mL/hr indicates oliguria, which can be a sign of dehydration or kidney impairment postoperatively. This finding should be reported to the provider for further evaluation. Choices A, B, and D are within normal parameters for a client who is 2 days postoperative following abdominal surgery and do not raise immediate concerns. Serosanguineous drainage on the dressing is an expected finding in the early postoperative period, a heart rate of 88/min is within the normal range, and a blood pressure of 110/70 mm Hg is also within normal limits.

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