Nursing Elites

1. When reviewing a client’s fluid and electrolyte status, what should the nurse report to the provider?

• A. Potassium 5.4
• B. Sodium 140
• C. Calcium 8.6
• D. Magnesium 2.0

Correct answer: A

Rationale: The correct answer is A: 'Potassium 5.4'. A potassium level of 5.4 is elevated (normal range is typically 3.5-5.0 mEq/L) and may indicate hyperkalemia, which can have serious cardiac implications. Elevated potassium levels can lead to life-threatening arrhythmias, so immediate reporting and intervention are necessary. Choice B, 'Sodium 140', falls within the normal range (135-145 mEq/L) and does not require immediate reporting. Choice C, 'Calcium 8.6', falls within the normal range (8.5-10.5 mg/dL) and is not an immediate concern. Choice D, 'Magnesium 2.0', is within the normal range (1.5-2.5 mEq/L) and does not need urgent reporting. Therefore, the nurse should prioritize reporting the elevated potassium level as it poses the most immediate risk.

2. A client is admitted with acute pyelonephritis. Which symptom should the nurse expect the client to report?

• A. Flank pain
• B. Pedal edema
• C. Hypotension
• D. Weight gain

Correct answer: A

Rationale: Flank pain is a classic symptom of acute pyelonephritis, which is a bacterial infection of the kidney. It occurs due to inflammation and irritation of the renal capsule, leading to pain in the flank region. Pedal edema (swelling in the feet and ankles) is more commonly associated with conditions like heart failure or kidney disease, not typically seen in acute pyelonephritis. Hypotension (low blood pressure) is a systemic symptom that may occur with severe infections but is not a specific hallmark of pyelonephritis. Weight gain is also not a typical symptom of acute pyelonephritis; instead, patients may experience weight loss due to decreased appetite and systemic effects of infection.

3. A nurse is providing education about cultural and religious traditions and rituals related to death for the assistive personnel on the unit. Which of the following information should the nurse include?

• A. People who practice Judaism stay with the body of the deceased until burial.
• B. People who practice Islam avoid cremation of the body.
• C. People who practice Buddhism prefer to have a brief funeral service.
• D. People who practice Hinduism prefer to have the body embalmed before cremation.

Correct answer: A

Rationale: The correct answer is A. In Judaism, it is customary for the body to be attended to by family or members of the community until burial. This practice is rooted in the belief of providing respect and care to the deceased individual. Choices B, C, and D are incorrect because they do not accurately reflect the cultural and religious traditions related to death for people who practice Islam, Buddhism, and Hinduism, respectively. People who practice Islam generally avoid cremation and opt for burial, Buddhists may have varying funeral service preferences, and Hindus often practice cremation without embalming the body.

4. A client with a history of coronary artery disease is experiencing chest pain. What is the priority action for the LPN/LVN to take?

• A. Administer nitroglycerin sublingually.
• B. Obtain a 12-lead ECG.
• C. Measure the client's vital signs.
• D. Administer oxygen via nasal cannula.

Correct answer: A

Rationale: The correct answer is to administer nitroglycerin sublingually. Administering nitroglycerin sublingually is the priority action for a client with chest pain and a history of coronary artery disease. Nitroglycerin helps dilate the coronary arteries, improving blood flow to the heart muscle and providing rapid relief of chest pain. Obtaining a 12-lead ECG, measuring vital signs, and administering oxygen are important actions but should follow the administration of nitroglycerin in the management of chest pain in a client with coronary artery disease.

5. A healthcare professional is preparing to administer enoxaparin subcutaneously to a client. Which of the following actions should the healthcare professional take?

• A. Administer the medication with the needle at a 45-degree angle.
• B. Administer the medication with the needle at a 90-degree angle.
• C. Inject the medication into the muscle.
• D. Pinch the skin before injecting.

Correct answer: B

Rationale: Enoxaparin is a medication that is administered subcutaneously, which means it should be injected into the fatty tissue layer beneath the skin. Administering enoxaparin at a 90-degree angle ensures proper absorption and reduces the risk of injecting the medication into muscle tissue, which could affect its effectiveness. Injecting the medication at a 45-degree angle may lead to improper absorption as it may not reach the subcutaneous tissue adequately. Injecting the medication into the muscle instead of subcutaneously can alter the absorption rate and therapeutic effects. Pinching the skin before injecting is not necessary for administering enoxaparin subcutaneously and may cause unnecessary discomfort to the client.

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