Nursing Elites

1. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

• A. Registered nurse who just floated from the surgical unit
• B. Registered nurse who just floated from the dialysis unit
• C. Registered nurse who was assigned the same client yesterday
• D. Licensed practical nurse with 5 years of experience on this floor

Correct answer: C

Rationale: The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is crucial to assess subtle changes in clients' conditions. Therefore, the registered nurse (RN) who previously cared for this client should be assigned again. Float nurses may lack knowledge of the unit and its clients, potentially leading to oversight of critical details. The licensed practical nurse, while experienced, may not possess the advanced assessment skills and education level of an RN to effectively evaluate and manage pericarditis in this client.

2. The nurse is administering intravenous fluids to a dehydrated patient. On the second day of care, the patient's weight has increased by 2.25 pounds. The nurse would expect that the patient's fluid intake has

• A. equaled urine output.
• B. exceeded urine output by 1 L.
• C. exceeded urine output by 2.5 L.
• D. exceeded urine output by 3 L.

Correct answer: B

Rationale: A weight gain of 1 kg, or approximately 2.2 to 2.5 lb, is generally equivalent to 1 liter (L) of fluid retained by the body. In this case, the patient's weight gain of 2.25 pounds suggests an excess fluid retention of approximately 1 liter, indicating that the patient's fluid intake has exceeded urine output by 1 liter. Choices C and D are incorrect as they overestimate the fluid excess based on the patient's weight gain. Choice A is incorrect as it implies an exact balance between fluid intake and urine output, which is not reflected in the given weight increase.

3. 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.

4. The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/hour. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take?

• A. Decrease the IV fluid rate and notify the provider.
• B. Increase the IV fluid rate and notify the provider.
• C. Request an order for a colloidal IV solution.
• D. Request an order for a hypertonic IV solution.

Correct answer: A

Rationale: The patient is showing signs of fluid volume excess, indicated by crackles in both lungs, increased heart rate, and elevated blood pressure. To address this, the nurse should decrease the IV fluid rate and notify the provider. Increasing the IV fluid rate would worsen fluid overload. Requesting colloidal or hypertonic IV solutions would exacerbate the issue by pulling more fluids into the intravascular space, leading to further volume overload.

5. A client recovering from a cystoscopy is being assessed by a nurse. Which assessment findings should alert the nurse to urgently contact the health care provider? (Select all that apply.)

• A. Decrease in urine output
• B. Blood clots present in the urine
• C. Prescription for metformin
• D. A & B

Correct answer: D

Rationale: After a cystoscopy, the nurse should monitor urine output and promptly contact the provider if there is a decrease or absence of urine output. Additionally, the nurse should assess for blood in the urine. While some pink-tinged urine may be expected, the presence of gross bleeding or blood clots warrants immediate provider notification. Tolerating oral fluids is a positive sign and does not require urgent intervention. Metformin would be a concern if the client received contrast dye, which is not used in a cystoscopy. A burning sensation when urinating is a common post-procedure experience and does not necessitate contacting the provider. Therefore, choices A and B are the correct answers as they indicate potentially serious complications that require immediate attention, while choices C and D do not align with urgent concerns following a cystoscopy.

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