Nursing Elites

1. Four hours following surgical repair of a compound fracture of the right ulna, the nurse is unable to palpate the client's right radial pulse. Which action should the nurse take first?

• A. Notify the healthcare provider of the finding immediately.
• B. Complete a neurovascular assessment of the right hand.
• C. Elevate the client's right hand on one or two pillows.
• D. Measure the client's blood pressure and apical pulse rate.

Correct answer: B

Rationale: Completing a neurovascular assessment of the right hand is the priority in this situation. This assessment will help determine the circulation, sensation, and movement of the affected limb, ensuring there are no complications like compartment syndrome or impaired perfusion. Notifying the healthcare provider immediately (Choice A) might be necessary but should come after assessing the client's neurovascular status. Elevating the client's right hand (Choice C) can be helpful in some cases but should not precede a neurovascular assessment. Measuring the client's blood pressure and apical pulse rate (Choice D) is important but not the priority when assessing a potential vascular compromise in the limb.

2. The client with chronic renal failure who is on a low-sodium diet should avoid which of the following foods?

• A. Fresh fruits.
• B. Canned soups.
• C. Lean meats.
• D. Whole grain bread.

Correct answer: B

Rationale: Canned soups are high in sodium, which can lead to fluid retention and hypertension in clients with chronic renal failure who are on a low-sodium diet. Fresh fruits, lean meats, and whole grain bread are generally lower in sodium and can be included in a low-sodium diet. Lean meats provide essential protein, fresh fruits offer vitamins and minerals, and whole grain bread provides fiber, making them suitable choices for individuals with chronic renal failure.

3. The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct

• A. dose.
• B. drug.
• C. frequency.
• D. route.

Correct answer: C

Rationale: The correct answer is 'frequency.' Trimethoprim-sulfamethoxazole (TMP-SMX) is typically prescribed to be taken twice daily, not four times a day (QID). The dose, drug, and route are already specified in the order, so the nurse should contact the provider to clarify the frequency of administration to ensure optimal treatment for the urinary tract infection caused by E. coli. Choosing 'dose' is incorrect because the dose of 160/800 is already provided in the order. 'Drug' is incorrect because the medication Trimethoprim-sulfamethoxazole (TMP-SMX) is explicitly stated in the prescription. 'Route' is incorrect as PO (by mouth) is also clearly indicated in the prescription.

4. A client with cardiovascular disease is scheduled to receive a daily dose of furosemide (Lasix). Which potassium level would cause the nurse to contact the physician before administering the dose?

• A. 3.0 mEq/L
• B. 3.8 mEq/L
• C. 4.2 mEq/L
• D. 5.1 mEq/L

Correct answer: A

Rationale: The normal serum potassium level in adults ranges from 3.5 to 5.1 mEq/L. A potassium level of 3.0 mEq/L is low, indicating hypokalemia and necessitating physician notification before administering furosemide, a loop diuretic that can further lower potassium levels. Potassium levels of 3.8 and 4.2 mEq/L are within the normal range, while a level of 5.1 mEq/L is high (hyperkalemia), but the critical value in this case is the low potassium level that requires immediate attention to prevent potential complications.

5. A pregnant client tells the nurse, “I am experiencing a burning pain when I urinate.” How should the nurse respond?

• A. This means labor will start soon. Prepare to go to the hospital.
• B. You probably have a urinary tract infection. Drink more cranberry juice.
• C. Make an appointment with your provider to have your infection treated.
• D. Your pelvic wall is weakening. Pelvic muscle exercises should help.

Correct answer: C

Rationale: Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. Choice A is incorrect because burning pain during urination does not signify the start of labor. Choice B is incorrect because while cranberry juice may help prevent urinary tract infections, it is not a treatment. Choice D is incorrect because burning pain when urinating is not indicative of weakening pelvic muscles.

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