Nursing Elites

1. An adult client who received partial thickness burns on 40% of the body in a house fire is admitted to the inpatient burn unit. Which fluid should the nurse prepare to administer during the client's burn recovery?

• A. 5% dextrose in water
• B. 5% dextrose in 0.25 normal saline
• C. Total parenteral nutrition
• D. Lactated Ringer's

Correct answer: D

Rationale: During the burn recovery phase, the nurse should prepare to administer Lactated Ringer's solution. Lactated Ringer's is the preferred fluid choice for burn patients as it helps replace lost fluids and electrolytes, maintain perfusion, and support organ function. Option A, 5% dextrose in water, is not the appropriate choice for fluid resuscitation in burn patients. Option B, 5% dextrose in 0.25 normal saline, does not provide the necessary electrolytes needed for burn recovery. Option C, Total parenteral nutrition, may be considered later in the treatment but is not the initial fluid of choice for burn recovery.

2. A nurse reviews a client’s urinalysis report. Which finding does the nurse recognize as abnormal?

• A. pH of 6.0
• B. An absence of protein
• C. The presence of ketones
• D. Specific gravity of 1.018

Correct answer: C

Rationale: The correct answer is C. The presence of ketones in the urine is abnormal. Ketones in the urine may indicate a state of ketosis, which is commonly seen in uncontrolled diabetes, fasting, or a low-carbohydrate diet. A normal pH range of urine is 4.5 to 7.8, making a pH of 6.0 within the normal range. An absence of protein is a normal finding in urine, as proteinuria (presence of protein) is abnormal. A specific gravity of 1.018 falls within the normal range of 1.016 to 1.022. Therefore, the presence of ketones is the abnormal finding in this scenario.

3. A client is receiving a continuous infusion of normal saline at 125 ml/hour post abdominal surgery. The client is drowsy and complaining of constant abdominal pain and a headache. Urine output is 800 ml over the past 24 hours with a central venous pressure of 15 mmHg. The nurse notes respiratory crackles and bounding central pulse. Vital signs: temperature 101.2 F (38.4 C), heart rate 96 beats/minute, respiration 24 breaths/minute, and blood pressure of 160/90 mmHg. Which intervention should the nurse implement first?

• A. Calculate total intake and output for the last 24 hours.
• B. Administer a PRN dose of acetaminophen.
• C. Decrease IV fluids to a keep vein open (KVO) rate.
• D. Review the last administration of IV pain medication.

Correct answer: C

Rationale: In this scenario, the client is showing signs of fluid volume excess, such as drowsiness, abdominal pain, headache, crackles in the lungs, bounding pulse, and elevated blood pressure. Decreasing the IV fluids to a keep vein open (KVO) rate is crucial to prevent further fluid overload. This intervention helps in balancing fluid intake and output to prevent complications associated with fluid volume excess. Calculating total intake and output (Choice A) may be necessary but not the immediate priority in managing fluid overload. Administering acetaminophen (Choice B) may help with managing the fever but does not address the underlying issue of fluid overload. Reviewing the last administration of IV pain medication (Choice D) is not the priority in this situation where fluid overload is a concern.

4. Which of the following is a characteristic symptom of hypothyroidism?

• A. Fatigue.
• B. Weight gain.
• C. Cold intolerance.
• D. Heat intolerance.

Correct answer: C

Rationale: The correct answer is 'Cold intolerance.' Hypothyroidism is associated with a decreased metabolic rate, leading to a decreased ability to regulate body temperature and a feeling of being cold. Fatigue (Choice A) and weight gain (Choice B) are also common symptoms of hypothyroidism due to the overall slowing down of bodily functions. Heat intolerance (Choice D) is more commonly associated with hyperthyroidism, where the body's metabolism is overactive, leading to increased heat production.

5. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patient’s provider to discuss an order for

• A. a low-potassium diet.
• B. intravenous sodium bicarbonate.
• C. Kayexalate and sorbitol.
• D. salt substitutes.

Correct answer: A

Rationale: In the scenario presented, the patient is experiencing mild hyperkalemia with a potassium level of 5.4 mEq/L. The appropriate intervention for mild hyperkalemia is a low-potassium diet to restrict potassium intake. This helps in managing and preventing further elevation of potassium levels. Intravenous sodium bicarbonate is not indicated as the patient's sodium level is normal at 140 mEq/L. Kayexalate, a cation-exchange resin, is typically used for severe hyperkalemia to promote potassium excretion. Salt substitutes, which often contain potassium chloride, should be avoided in patients with hyperkalemia as they can exacerbate the condition by increasing potassium levels further.

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