Nursing Elites

1. A client with a left leg cast is being taught how to use crutches. Which of the following statements should indicate to the nurse that the client understands the teaching?

• A. When descending stairs, I will first shift my weight to my right (unaffected) leg.
• B. I will use crutches to support my weight on my left leg.
• C. When ascending stairs, I will lead with my left leg.
• D. I will keep my crutches under my arms for support.

Correct answer: A

Rationale: The correct answer is A. Shifting weight to the unaffected leg when descending stairs is crucial for maintaining balance and safety. This technique helps prevent falls and distributes weight appropriately. Choices B, C, and D are incorrect because using crutches to support the weight on the injured leg, leading with the injured leg when ascending stairs, and keeping crutches under the arms are all potentially unsafe practices that could lead to further injury or accidents.

2. A client with chronic kidney disease is being assessed. Which laboratory value would be most concerning?

• A. Serum creatinine of 3.0 mg/dL
• B. Blood urea nitrogen (BUN) of 45 mg/dL
• C. Serum potassium of 6.5 mEq/L
• D. Hemoglobin of 10 g/dL

Correct answer: C

Rationale: In a client with chronic kidney disease, an elevated serum potassium level (hyperkalemia) is the most concerning finding. Hyperkalemia can lead to life-threatening cardiac dysrhythmias due to its effect on the electrical conduction system of the heart. Monitoring and managing serum potassium levels are crucial in patients with chronic kidney disease to prevent serious complications. While elevated serum creatinine (Choice A) and Blood Urea Nitrogen (BUN) levels (Choice B) indicate impaired kidney function, hyperkalemia poses an immediate risk of cardiac complications. Hemoglobin levels (Choice D) are typically lower in chronic kidney disease due to decreased erythropoietin production, but they do not present an immediate life-threatening risk like hyperkalemia.

3. A client has a new prescription for parenteral nutrition (PN) in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include in the plan of care?

• A. Monitor blood glucose levels daily.
• B. Change the PN infusion bag every 24 hours.
• C. Prepare the client for a central venous line.
• D. Administer the PN and fat emulsion together.

Correct answer: C

Rationale: When a client requires parenteral nutrition (PN) with a high dextrose concentration, such as 20%, it typically has a high osmolarity. High osmolarity solutions should be infused through a central venous line to prevent peripheral vein irritation and potential complications. Therefore, preparing the client for a central venous line is essential for the safe administration of PN with high dextrose. Monitoring blood glucose levels daily is important but not directly related to the need for a central venous line. Changing the PN infusion bag every 24 hours helps prevent bacterial contamination, but it is not the most critical action in this scenario. Administering the PN and fat emulsion together or separately is a matter of compatibility and administration guidelines, but it is not the key concern in this situation.

4. A nurse in an outpatient clinic is caring for a client who has a new prescription for an antihypertensive medication. Which of the following instructions should the nurse give the client?

• A. “Get up and change positions slowly.”
• B. “Avoid eating aged cheese and smoked meat.”
• C. “Report any unusual bruising or bleeding to the doctor immediately.”
• D. “Eat the same amount of foods that contain vitamin K every day.”

Correct answer: A

Rationale: The correct instruction for the nurse to give the client who is starting on antihypertensive medication is to 'Get up and change positions slowly.' Antihypertensive medications can cause orthostatic hypotension, a drop in blood pressure when changing positions, so changing positions slowly helps prevent this adverse effect. Choice B about avoiding aged cheese and smoked meat is more relevant for clients taking monoamine oxidase inhibitors (MAOIs) due to potential interactions. Choice C regarding reporting unusual bruising or bleeding is more applicable for clients on anticoagulants. Choice D about consuming consistent amounts of vitamin K-containing foods daily is important for clients taking warfarin, not antihypertensive medications.

5. During the admission assessment of a terminally ill male client, he states that he is agnostic. What is the best nursing action in response to this statement?

• A. Provide information about the hours and location of the chapel
• B. Document the statement of the client’s spiritual assessment
• C. Invite the client to a healing service for people of all religions
• D. Offer to contact a spiritual advisor of the client’s choice

Correct answer: B

Rationale: The best nursing action in response to a terminally ill client stating their agnostic beliefs is to document the client's spiritual assessment. By documenting this information, the healthcare team can ensure that the client's beliefs are acknowledged and respected in their care plan. Providing information about the chapel's hours or inviting the client to a healing service may not align with the client's beliefs and preferences. Offering to contact a spiritual advisor of the client's choice may not be necessary if the client has clearly stated their agnostic beliefs, as they may not wish to engage in spiritual counseling.

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