Nursing Elites

1. The home health nurse provides teaching about insulin self-injection to a client who was recently diagnosed with diabetes mellitus. When the client begins to perform a return demonstration of an insulin injection into the abdomen, which instruction should the nurse provide?

• A. Select a different injection site
• B. Continue with the insulin injection
• C. Keep the skin flat rather than bunched
• D. Lie down flat for better skin exposure

Correct answer: B

Rationale: Choosing to continue with the insulin injection is the correct instruction in this scenario because it allows the client to demonstrate proper technique and reinforces their learning. Selecting a different injection site (choice A) is not necessary if the client is injecting into the abdomen as it is a suitable site. Keeping the skin flat rather than bunched (choice C) is a good practice but is not the priority in this situation where the client is demonstrating the injection technique. Lying down flat for better skin exposure (choice D) is not required and may not be practical for the client during routine self-injections.

2. A nurse has a prescription to insert a nasogastric tube into the stomach of an assigned client. Which action should the nurse take to insert the tube safely and easily?

• A. Placing the tube in warm water
• B. Hyperextending the head while inserting the tube
• C. Removing the tube if any resistance to insertion is met
• D. Asking the client to swallow as the tube is being advanced

Correct answer: D

Rationale: The correct action for the nurse to take to insert a nasogastric tube safely and easily is asking the client to swallow as the tube is being advanced. This action helps facilitate the passage of the tube through the esophagus into the stomach. Placing the tube in warm water (Choice A) is not a recommended practice for nasogastric tube insertion. Hyperextending the head (Choice B) can cause discomfort and is not necessary for safe insertion. Removing the tube if resistance is met (Choice C) is incorrect as it may cause harm or discomfort to the client. Asking the client to swallow helps the tube pass more smoothly and comfortably.

3. The patient is beginning furosemide and has started a 2-week course of a steroid medication. What should the nurse recommend?

• A. Avoid consuming licorice to prevent excess potassium loss.
• B. Report a urine output less than 600 mL/24 hours.
• C. Obtain an order for a potassium supplement.
• D. Take the furosemide in the morning.

Correct answer: C

Rationale: When a patient is taking furosemide and a steroid medication, there is an increased risk of potassium loss due to the interaction between the two drugs. Consuming licorice should be avoided as it can worsen potassium loss. Reporting a urine output less than 600 mL/24 hours is not directly related to the drug interaction and may not be necessary. Taking furosemide at bedtime is not the primary concern when a patient is concurrently on a steroid medication and furosemide. Therefore, obtaining an order for a potassium supplement is the most appropriate recommendation to counteract the potential potassium loss.

4. A client is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take?

• A. Document the finding in the client’s record.
• B. Evaluate the tube as working in the hand-off report.
• C. Clamp the tube in preparation for removing it.
• D. Assess the client’s abdomen and vital signs.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to assess the client’s abdomen and vital signs. The nephrostomy tube should have a consistent amount of drainage, and a decrease may indicate obstruction. Before notifying the provider, the nurse must assess the client for pain, distention, and changes in vital signs. This assessment is crucial to gather essential information to report accurately. Documenting the finding without further assessment may delay necessary intervention. Evaluating the tube as working in the hand-off report or clamping the tube prematurely are not appropriate actions and could lead to complications if there is an obstruction.

5. What is an expected outcome when a client is receiving an IV administration of furosemide?

• A. Increased blood pressure.
• B. Increased urine output.
• C. Decreased pain.
• D. Decreased premature ventricular contractions.

Correct answer: B

Rationale: The correct answer is B: Increased urine output. Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle in the kidneys, leading to increased urine production. This diuretic effect helps to reduce fluid volume in the body, making it an expected outcome when a client is receiving furosemide. Choice A, increased blood pressure, is incorrect because furosemide typically causes a decrease in blood pressure due to its diuretic effect. Choice C, decreased pain, and choice D, decreased premature ventricular contractions, are unrelated to the pharmacological action of furosemide.

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