Nursing Elites

1. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 50 ml/hour
• B. 25 ml/hour
• C. 75 ml/hour
• D. 100 ml/hour

Correct answer: C

Rationale: To calculate the infusion rate, convert 1 mg to 1,000 mcg (1 mg = 1,000 mcg) and then use the formula D/H x Q, where D is the desired dose, H is the dose on hand, and Q is the quantity of solution. In this case, it would be 300 mcg/hour / 1,000 mcg x 250 ml = 75 ml/hour. Therefore, the nurse should program the infusion pump to deliver 75 ml/hour. Choice A (50 ml/hour), Choice B (25 ml/hour), and Choice D (100 ml/hour) are incorrect as they do not correspond to the calculated rate of 75 ml/hour.

2. The charge nurse of the critical care unit informed at the beginning of the shift that a less than optimal number of registered nurses would be working that shift. In planning assignments, which client should receive the most care hours by a registered nurse?

• A. A 34-year-old admitted today after an emergency appendectomy who has a peripheral intravenous catheter and a Foley catheter.
• B. A 48-year-old marathon runner with a central venous catheter experiencing nausea and vomiting due to electrolyte disturbance following a race.
• C. A 63-year-old chain smoker with chronic bronchitis receiving oxygen via nasal cannula and a saline-locked peripheral intravenous catheter.
• D. An 82-year-old client with Alzheimer's disease and a newly fractured femur with a Foley catheter and soft wrist restraints applied.

Correct answer: D

Rationale: The 82-year-old client with Alzheimer's disease and a newly fractured femur should receive the most care hours by a registered nurse because they are at the highest risk for injury and complications. The client's age, diagnosis of Alzheimer's disease, and the presence of a newly fractured femur along with the Foley catheter and wrist restraints indicate a need for close monitoring and care. Choice A is less critical as the client is stable post-appendectomy. Choice B, though experiencing symptoms, is not at the same level of risk as the client in Choice D. Choice C, while requiring oxygen support, does not have the same level of acuity and complexity as the client in Choice D.

3. A 46-year-old male client who had a myocardial infarction 24 hours ago comes to the nurse's station fully dressed and wanting to go home. He tells the nurse that he is feeling much better at this time. Based on this behavior, which nursing problem should the nurse formulate?

• A. Ineffective coping related to denial.
• B. Risk for impaired cardiac function.
• C. Noncompliance related to lack of knowledge.
• D. Anxiety related to hospitalization.

Correct answer: A

Rationale: The correct answer is A: Ineffective coping related to denial. The client's desire to leave the hospital shortly after a myocardial infarction despite the severity of the condition indicates denial and ineffective coping. This behavior could lead to complications as the client may not adequately address his health needs. Choice B, Risk for impaired cardiac function, is not the most appropriate nursing problem in this scenario as the client's behavior is more indicative of psychological coping issues rather than a direct physiological risk at this moment. Choice C, Noncompliance related to lack of knowledge, does not align with the client's behavior of wanting to leave the hospital. Choice D, Anxiety related to hospitalization, may not be the best option as the client's behavior is more suggestive of denial rather than anxiety about being hospitalized.

4. The nurse is caring for a client with acute kidney injury (AKI) secondary to gentamicin therapy. The client's serum blood potassium is elevated. Which finding requires immediate action by the nurse?

• A. Anuria for the last 12 hours.
• B. Tachycardia and hypotension.
• C. Decreased urine output.
• D. Elevated blood urea nitrogen (BUN) levels.

Correct answer: A

Rationale: The correct answer is A. Anuria for the last 12 hours. Anuria, the absence of urine output, indicates complete kidney failure and is a medical emergency that requires immediate attention. In acute kidney injury (AKI), the kidneys are unable to filter waste from the blood effectively, leading to a buildup of toxins and electrolyte imbalances like elevated blood potassium levels. Tachycardia and hypotension (choice B) can be seen in AKI but do not reflect the urgency of addressing anuria. Decreased urine output (choice C) is concerning but not as critical as the absence of urine production. Elevated blood urea nitrogen (BUN) levels (choice D) are indicative of kidney dysfunction but do not demand immediate action as anuria does.

5. During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action should the nurse take first?

• A. Give the client 4 ounces of orange juice
• B. Call 911 to summon emergency assistance
• C. Check the client for lacerations or fractures
• D. Assess client's blood sugar level

Correct answer: C

Rationale: The correct first action for the nurse to take after an elderly client with diabetes slips and falls is to check the client for lacerations or fractures. This is crucial to assess for any immediate physical injuries that may need immediate attention. Giving orange juice or assessing the blood sugar level may be important later but checking for injuries takes precedence to ensure the client's safety and well-being. Calling 911 should be considered if there are severe injuries or if the client is in distress, but checking for lacerations or fractures is the priority at the moment.

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