Nursing Elites

1. The healthcare provider calculates the IV flow rate for a patient receiving lactated Ringer's solution. The patient needs to receive 2000mL of Lactated Ringer's over 36 hours. The IV infusion set has a drop factor of 15 drops per milliliter. How many drops per minute should the healthcare provider set the IV to deliver?

• A. 8
• B. 10
• C. 14
• D. 18

Correct answer: C

Rationale: To determine the drops per minute, we use the formula Drops Per Minute = (Milliliters x Drop Factor) / Time in Minutes. In this case, Drops Per Minute = (2000mL x 15 drops/mL) / (36 hours x 60 minutes/hour) = 30000 / 2160 = 13.89 (approximately 14). Therefore, the correct answer is 14 drops per minute. Choice A (8), Choice B (10), and Choice D (18) are incorrect as they do not correctly calculate the drops per minute based on the given information.

2. The mother of a child who had a cleft palate repair 4 days ago is receiving home care instructions. Which statement by the mother indicates the need for further instruction?

• A. ''I will use a short nipple on the bottle.''
• B. ''I should avoid using straws for drinking.''
• C. ''I can give my child the pacifier in 2 weeks.''
• D. ''I may give my baby food mixed with water.''

Correct answer: B

Rationale: The correct answer is ''I should avoid using straws for drinking.'' After a cleft palate repair, the child should avoid straws, pacifiers, spoons, and fingers near the mouth for 7 to 10 days to prevent injury to the surgical site. Allowing the child to use a straw can create negative pressure in the mouth, potentially disrupting the healing process. The other options are appropriate postoperative instructions for a child who had a cleft palate repair and do not pose a risk to the surgical site.

3. A 28-year-old male has been found wandering around in a confusing pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?

• A. Blood sugar check
• B. CT scan
• C. Blood cultures
• D. Arterial blood gases

Correct answer: A

Rationale: In a 28-year-old male presenting with confusion, sweating, and pallor, the most likely cause is hypoglycemia, especially with no mention of trauma or infection. Therefore, the initial test to be performed should be a blood sugar check to rule out low blood sugar levels. Checking blood sugar levels is crucial in such a scenario as hypoglycemia can lead to altered mental status. A CT scan (choice B) is not typically the initial test for altered mental status without any focal neurological signs or head trauma. Blood cultures (choice C) are more relevant in cases suspected of infection, which is not a primary concern in this scenario. Arterial blood gases (choice D) may be considered later if there are concerns about respiratory status or acid-base disturbances, but in this case, checking the blood sugar level is the most immediate and appropriate action.

4. The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed?

• A. A large air leak in the water-seal chamber
• B. 400 mL of blood in the collection chamber
• C. Complaint of pain with each deep inspiration
• D. Subcutaneous emphysema at the insertion site

Correct answer: B

Rationale: The nurse should be most concerned if 400 mL of blood is observed in the collection chamber as it may indicate the patient is at risk of developing hypovolemic shock. A large air leak in the water-seal chamber is expected initially after chest tube placement for a pneumothorax. While pain with deep inspiration should be treated, it is not as urgent as the risk of continued hemorrhage. Subcutaneous emphysema is not uncommon in a patient with pneumothorax and is usually harmless. However, a large amount of blood in the collection chamber is a more critical finding that requires immediate attention to prevent potential complications.

5. A patient presents to the office with a pencil that has completely penetrated the palm of her hand. Which of the following treatments would be BEST in this situation?

• A. Assist the doctor while he sedates the patient and removes the pencil from her hand.
• B. Have the patient gently pull the pencil out of her hand and assist the physician with stitches.
• C. Wrap a gauze around the pencil, securing it as much as possible until the patient can get to a local emergency room.
• D. Tell the patient to go to the local emergency room. With a doctor's order, give the patient some aspirin for the pain.

Correct answer: C

Rationale: Penetrating wounds that leave an object behind may have damaged important blood vessels. Removing the object may lead to significant bleeding. The correct approach is to gently wrap the wound with the object in place to help control bleeding and prevent further injury. The patient should be taken promptly to the nearest emergency room where healthcare professionals can safely and appropriately remove the object and provide necessary treatment. Choice A is incorrect because removing the pencil without proper medical evaluation can worsen the injury. Choice B is incorrect because pulling out the object can cause additional damage and bleeding. Choice D is incorrect because giving aspirin without knowing the extent of the injury and causing potential drug interactions can be harmful.

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