Nursing Elites

1. High uric acid levels can develop in clients who are receiving chemotherapy. This can be caused by:

• A. the inability of the kidneys to excrete the drug metabolites.
• B. rapid cell catabolism.
• C. toxic effects of the prophylactic antibiotics that are given concurrently.
• D. the altered blood pH from the acidic nature of the drugs.

Correct answer: B

Rationale: The correct answer is 'rapid cell catabolism.' During chemotherapy, rapid cell destruction occurs, leading to an increase in uric acid levels as a byproduct of cell breakdown. High uric acid levels are primarily a result of the rapid breakdown of cells during chemotherapy, not due to the kidneys' inability to excrete drug metabolites (Choice A). The prophylactic antibiotics given concurrently do not directly cause high uric acid levels (Choice C). The altered blood pH from the acidic nature of the drugs (Choice D) is not a direct cause of elevated uric acid levels; the main mechanism is the rapid cell catabolism that occurs during chemotherapy.

2. When administering intravenous electrolyte solution, what precaution should the nurse take?

• A. Infuse hypertonic solutions cautiously.
• B. Mix no more than 60 mEq of potassium per liter of fluid.
• C. Prevent infiltration of calcium, which causes tissue necrosis and sloughing.
• D. Monitor the client's digitalis dosage for adjustments due to IV calcium.

Correct answer: C

Rationale: When administering intravenous electrolyte solutions, preventing the infiltration of calcium is crucial to avoid tissue necrosis and sloughing, making choice C the correct answer. Choice A is revised to 'Infuse hypertonic solutions cautiously' because hypertonic solutions should be infused cautiously to prevent adverse effects. Choice B is corrected to 'Mix no more than 60 mEq of potassium per liter of fluid' as exceeding this limit can lead to hyperkalemia. Choice D is modified to 'Monitor the client's digitalis dosage for adjustments due to IV calcium' as it is essential to monitor the digitalis dosage for potential adjustments when IV calcium is administered; however, this choice is incorrect here as it inaccurately suggests adjusting the digitalis dosage due to IV calcium, which could lead to harmful effects.

3. The nurse manager is having a problem on the unit with one staff person having repetitive tardiness and leaving the unit with orders not initiated. Which action by the manager would be best?

• A. Call the staff nurse in and place them on a work improvement plan after a 3-day suspension
• B. Have the other staff gather additional information on the tardy staff member
• C. Call the staff nurse in for an interview to investigate the problem and possible solutions
• D. Assign a mentor to assist the staff member in arriving on time

Correct answer: C

Rationale: The correct action for the nurse manager would be to call the staff nurse in for an interview to discuss the issues of repetitive tardiness and incomplete tasks. This approach allows the staff member to explain the situation, and together with the manager, develop a plan to address the problems. Choice A is incorrect as it immediately involves suspension without investigation or support. Choice B is not the best course of action as it does not involve direct communication with the staff member in question. Choice D, assigning a mentor to help the staff member, could be beneficial but does not directly address the immediate issues of tardiness and incomplete tasks.

4. A woman is in the active phase of labor. An external monitor has been applied, and a fetal heart deceleration of uniform shape is observed, beginning just as the contraction is underway and returning to the baseline at the end of the contraction. Which of the following nursing actions is most appropriate?

• A. Administer O2.
• B. Turn the client on her left side.
• C. Notify the physician.
• D. No action is necessary

Correct answer: D

Rationale: This scenario describes early deceleration due to head compression, which is a benign finding in labor. Early decelerations mirror the contractions and do not require any intervention as they are considered a normal response to fetal head compression. The fetal heart rate returns to baseline at the end of the contraction. In this case, the correct action is no action at the moment. Close monitoring of the mother and baby is essential, but immediate intervention is not required. Administering O2 (Choice A) or turning the client on her left side (Choice B) is not indicated for early decelerations. Notifying the physician (Choice C) is unnecessary for this type of deceleration.

5. During the admission assessment for a client undergoing breast augmentation, which information should the nurse prioritize reporting to the surgeon before surgery?

• A. The client is concerned about who will care for her two children while she recovers.
• B. The client has a history of postoperative dehiscence after a previous C-section.
• C. The client's statement that her last menstrual period was 8 weeks prior.
• D. The client's concerns over pain control postoperatively.

Correct answer: C

Rationale: The most important information for the nurse to report to the surgeon before surgery is the client's statement that her last menstrual period was 8 weeks prior. This information is crucial as the client may be pregnant, and a pregnancy test will need to be completed before administering any anesthetic agents. Reporting this detail ensures patient safety and prevents potential risks associated with anesthesia. Choices A, B, and D are important aspects of care but do not take precedence over the need to rule out pregnancy before surgery.

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