Nursing Elites

1. An RN is making assignments for client care to an LPN at the beginning of the shift. Which of the following assignments should the LPN question?

• A. Assisting a client who is 24 hr postop to use an incentive spirometer
• B. Collecting a clean catch urine specimen from a client who was admitted on the previous shift
• C. Providing nasopharyngeal suctioning for a client who has pneumonia
• D. Replacing the cartridge and tubing on a PCA pump

Correct answer: D

Rationale: The LPN should question the assignment of replacing the PCA pump cartridge and tubing as it is outside the LPN's scope of practice. LPNs are not trained to handle tasks related to PCA pumps, which involve medication administration and monitoring that are typically within the RN's responsibilities. Assisting a postop client with an incentive spirometer (Choice A), collecting a clean catch urine specimen (Choice B), and providing nasopharyngeal suctioning for a client with pneumonia (Choice C) are all tasks that fall within the LPN's scope of practice and do not require questioning by the LPN.

2. A client is receiving IV fluids and has developed phlebitis. What is the next step the nurse should take?

• A. Monitor the site for further swelling
• B. Remove the catheter and place it in another site
• C. Reduce the flow rate of IV fluids
• D. Switch to oral hydration

Correct answer: B

Rationale: The correct next step when a client develops phlebitis while receiving IV fluids is to remove the catheter and place it in another site. Phlebitis is inflammation of a vein, and leaving the catheter in the same site can lead to further complications. Monitoring the site for further swelling, as in choice A, is not enough as the source of inflammation needs to be removed. Choice C, reducing the flow rate, may not address the underlying issue causing phlebitis. Switching to oral hydration, as in choice D, is not necessary for addressing phlebitis related to IV fluid administration.

3. A nurse is caring for a 37-year-old woman with metastatic ovarian cancer admitted for nausea and vomiting. The physician orders total parenteral nutrition (TPN), a nutritional consult, and diet recall. Which of the following is the BEST indication that the patient's nutritional status has improved after 4 days?

• A. The patient eats most of the food served to her
• B. The patient has gained 1 pound since admission
• C. The patient's albumin level is 4.0mg/dL
• D. The patient's hemoglobin is 8.5g/dL

Correct answer: C

Rationale: An improved albumin level is the best indicator of improved nutritional status after TPN. Albumin is a key protein that reflects the body's overall nutritional status and is commonly used to assess nutritional health. Choices A, B, and D are not as reliable indicators of improved nutritional status. Choice A may not accurately reflect nutritional improvement as it could be influenced by factors other than nutrition. Choice B may indicate fluid retention or loss rather than true nutritional improvement. Choice D, hemoglobin level, is more related to anemia and oxygen-carrying capacity of the blood, rather than nutritional status.

4. Which dietary advice is most appropriate for a client with chronic kidney disease?

• A. Increase intake of fruits and vegetables
• B. Limit intake of potassium-rich foods
• C. Increase intake of dairy products
• D. Reduce intake of protein-rich foods

Correct answer: B

Rationale: The most appropriate dietary advice for a client with chronic kidney disease is to limit intake of potassium-rich foods. In chronic kidney disease, the kidneys have difficulty filtering potassium from the blood, leading to high levels that can be harmful. Therefore, reducing potassium intake is crucial to prevent complications. Choices A, C, and D are not the best options for individuals with chronic kidney disease. Increasing intake of fruits and vegetables (choice A) may actually increase potassium consumption. Increasing intake of dairy products (choice C) can lead to higher phosphorus and potassium levels. Reducing protein-rich foods (choice D) is not the primary focus in the early stages of chronic kidney disease, as protein is necessary for overall health unless kidney function declines significantly.

5. What are the potential complications of a patient receiving total parenteral nutrition (TPN)?

• A. Infection and electrolyte imbalance
• B. Hyperglycemia and sepsis
• C. Kidney failure and hypovolemia
• D. Fluid overload and liver damage

Correct answer: A

Rationale: Infection and electrolyte imbalance are common complications of TPN. Infection can occur due to the invasive nature of TPN, which provides a direct route for pathogens. Electrolyte imbalances can arise from the composition of the TPN solution or improper monitoring. Hyperglycemia and sepsis (Choice B) are potential complications but are not as directly associated with TPN as infection and electrolyte imbalance. Kidney failure and hypovolemia (Choice C) are less common complications of TPN. Fluid overload and liver damage (Choice D) are potential complications but are not as frequently observed as infection and electrolyte imbalance.

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