Nursing Elites

1. While the client is receiving total parenteral nutrition (TPN), which lab test should be evaluated?

• A. Hemoglobin
• B. Creatinine
• C. Blood glucose
• D. White blood cell count

Correct answer: C

Rationale: When a client is receiving total parenteral nutrition (TPN), monitoring blood glucose levels is crucial as TPN solutions contain high amounts of glucose. This monitoring helps prevent hyperglycemia or hypoglycemia. Evaluating hemoglobin (choice A) is not directly related to TPN administration. Creatinine (choice B) is more relevant for assessing kidney function. White blood cell count (choice D) is important for evaluating immune function and infection, but not specifically tied to TPN administration.

2. A client is 2 days post-operative colon resection. After a coughing episode, the client's wound eviscerates. Which nursing action is most appropriate?

• A. Reinsert the protruding organ and cover with 4x4s
• B. Cover the wound with a sterile 4x4 and ABD dressing
• C. Cover the wound with a sterile saline-soaked dressing
• D. Apply an abdominal binder and manual pressure to the wound

Correct answer: B

Rationale: In the scenario where a client's wound eviscerates, the most appropriate nursing action is to cover the wound with a sterile saline-soaked dressing. Reinserting the protruding organ, as mentioned in choice A, is incorrect because it can lead to further complications requiring the client to return to surgery. Choice B, covering the wound with a sterile 4x4 and ABD dressing, is not ideal as it may not provide adequate protection and moisture for the exposed tissue. Choice D, applying an abdominal binder and manual pressure to the wound, is inappropriate as it does not address the specific needs of wound evisceration. Covering the wound with a sterile saline-soaked dressing helps maintain a moist environment, protects the exposed tissue, and prevents infection, promoting optimal wound healing and reducing the risk of complications.

3. To decrease a client's use of denial and increase the client's expression of feelings, what should the nurse do?

• A. Tell the client to stop using the defense mechanism of denial
• B. Positively reinforce each expression of feelings
• C. Instruct the client to express feelings
• D. Challenge the client each time denial is used

Correct answer: B

Rationale: The most appropriate approach to decrease a client's use of denial and promote the expression of feelings is to positively reinforce each expression of feelings. This method helps the client feel supported and validated, encouraging them to continue expressing their emotions openly. Positively reinforcing the expression of feelings can help reduce the need for denial as the client learns that their emotions are acknowledged and accepted. Choices A, C, and D are incorrect. Choice A of telling the client to stop using denial is too directive and may be ineffective. Instructing the client to express feelings (Choice C) lacks positive reinforcement, and challenging the client each time denial is used (Choice D) can create a confrontational environment that hinders therapeutic progress.

4. While the client is receiving quinidine, the nurse should monitor the ECG for:

• A. Peaked P wave
• B. Elevated ST segment
• C. Inverted T wave
• D. Prolonged QT interval

Correct answer: D

Rationale: Quinidine can cause widened Q-T intervals and heart block, leading to a prolonged QT interval on the ECG. Other signs of myocardial toxicity associated with quinidine include notched P waves and widened QRS complexes. Common side effects of quinidine include diarrhea, nausea, and vomiting, while less common effects may include tinnitus, vertigo, headache, visual disturbances, and confusion. Monitoring for a prolonged QT interval is crucial due to the potential risk of serious arrhythmias. Choices A, B, and C are not typically associated with the use of quinidine and are therefore incorrect in this context.

5. The licensed practical nurse assigned to the postpartum unit is preparing to administer Rhogam to a postpartum client. Which woman is not a candidate for RhoGam?

• A. A gravida IV para 3 that is Rh negative with an Rh-positive baby
• B. A gravida I para 1 that is Rh negative with an Rh-positive baby
• C. A gravida II para 0 that is Rh negative admitted after a stillbirth delivery
• D. A gravida IV para 2 that is Rh negative with an Rh-negative baby

Correct answer: D

Rationale: The mothers in answers A, B, and C all require RhoGam as they are Rh negative with an Rh-positive baby or have experienced a stillbirth delivery, making them candidates for RhoGam injection. The mother in answer D is the only one who does not require Rhogam because she is Rh negative with an Rh-negative baby, eliminating the need for RhoGam administration.

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