Nursing Elites

1. A healthcare professional is reviewing laboratory data for a client who has chronic kidney disease. Which of the following findings should the healthcare professional expect?

• A. Increased creatinine.
• B. Increased hemoglobin.
• C. Increased bicarbonate.
• D. Increased calcium.

Correct answer: A

Rationale: In chronic kidney disease, the kidneys are unable to effectively filter waste products from the blood, leading to an accumulation of creatinine. Creatinine levels are commonly elevated in individuals with impaired kidney function, making it a key indicator of kidney health. Therefore, an increased creatinine level would be an expected finding in a client with chronic kidney disease.

2. During physical therapy, a client with Parkinson's disease makes the following statements. Which statement indicates the need for a referral to physical therapy?

• A. ''I have been experiencing more tremors in my left arm than before''
• B. ''I noticed that I am having a harder time holding on to my toothbrush''
• C. ''Lately, I feel like my feet are freezing up, as they are stuck to the ground''
• D. ''Sometimes, I feel I am making a chewing motion when I'm not eating''

Correct answer: C

Rationale: Feeling like the feet are freezing up and sticking to the ground is a common symptom of Parkinson's disease known as 'freezing of gait.' This symptom significantly impacts mobility and can be dangerous, indicating the need for specialized physical therapy interventions to address gait disturbances and improve mobility.

3. A client in labor is receiving oxytocin. Which of the following findings indicates that the nurse should increase the rate of infusion?

• A. Urine output of 20 ml/hr.
• B. Montevideo units constantly at 300 mm Hg.
• C. FHR pattern showing absent variability.
• D. Contractions occurring every 5 minutes and lasting 30 seconds.

Correct answer: B

Rationale: Montevideo units measure the strength and frequency of contractions during labor. A consistent Montevideo units reading of 300 mm Hg or higher is indicative of effective uterine contractions. In this scenario, an increase in the rate of oxytocin infusion may be warranted to further augment contractions and promote progress in labor. The other options, such as low urine output, absent variability in fetal heart rate, and short contractions, do not directly correlate with the need for an increase in oxytocin infusion rate.

4. A healthcare provider is performing a gastric lavage for a client who has upper gastrointestinal bleeding. Which of the following actions should the healthcare provider take?

• A. Instill 500 ml of solution through the NG tube.
• B. Insert a large-bore NG tube.
• C. Use a cold irrigation solution.
• D. Instruct the client to lie on their right side.

Correct answer: B

Rationale: During a gastric lavage procedure for upper gastrointestinal bleeding, inserting a large-bore NG tube is essential to effectively remove gastric contents and blood. This tube allows for efficient irrigation and suction, aiding in the removal of harmful substances from the stomach. Instilling a large volume of solution or using a cold irrigation solution can lead to complications such as fluid overload or hypothermia. Instructing the client to lie on their right side is not directly related to the gastric lavage procedure.

5. A client has had a cast applied, and a nurse is providing care. Which of the following actions should the nurse take first?

• A. Place an ice pack over the cast.
• B. Palpate the pulse distal to the cast.
• C. Teach the client to keep the cast clean and dry.
• D. Position the casted extremity on a pillow.

Correct answer: B

Rationale: When caring for a client with a newly applied cast, the nurse's priority should be to assess the circulation by palpating the pulse distal to the cast. This is crucial to ensure there is no compromise in blood flow, which could lead to serious complications. Placing an ice pack over the cast, teaching the client about cast care, and positioning the casted extremity on a pillow are important interventions but should follow the assessment of circulation.

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