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. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain breakthrough for a morphine drip is not working?

• A. The client complains of discomfort at the IV insertion site
• B. The client states 'I just can't get relief from my pain.'
• C. The level of the drug is 100 ml at 8 AM and is 80 ml at noon
• D. The level of the drug is 100 ml at 8 AM and is 50 ml at noon

Correct answer: C

Rationale: The correct answer is that the level of the drug is 100 ml at 8 AM and is 80 ml at noon. With a basal rate of 10 mL per hour, a total of 40 mL should have been infused by noon, leaving only 60 mL in the container. Any amount greater than 60 mL at noon indicates that the pump is not functioning properly. Therefore, the finding of 80 mL at noon suggests the pump is not delivering the expected medication volume. Choices A and B are related to the client's symptoms and may indicate the need for pain management assessment but do not specifically indicate pump malfunction. Choice D, where the level drops to 50 mL at noon, would actually indicate that the pump is working effectively, as the expected volume has been delivered.

3. What preparation should be made for a client undergoing a KUB (Kidney, Ureter, Bladder) radiography test?

• A. Client must be NPO before the examination
• B. Enema should be administered before the examination
• C. Medicate the client with furosemide 20 mg IV 30 minutes before the examination
• D. No special orders are necessary for this examination

Correct answer: D

Rationale: The correct answer is that no special orders are necessary for a KUB radiography test. It is important to inform the client to remove any clothing, jewelry, or objects that may interfere with the test. Option A is incorrect because there is no need for the client to be NPO before this examination. Option B is incorrect as enemas are not routinely administered prior to a KUB radiography test. Option C is incorrect as there is no need to medicate the client with furosemide before this examination.

4. What is a priority problem for a child with severe edema caused by nephrotic syndrome?

• A. Risk for constipation
• B. Risk for skin breakdown
• C. Inability to regulate body temperature
• D. Consuming more calories or nutrients than the body requires

Correct answer: B

Rationale: In nephrotic syndrome, characterized by massive proteinuria, hypoalbuminemia, and edema, a child with severe edema is at high risk for skin breakdown. The priority concern is to prevent skin breakdown by cleaning skin surfaces and ensuring adequate separation with clothing to avoid irritation. The child with nephrotic syndrome is typically anorexic, making consuming more calories or nutrients than necessary not a concern. Risk for constipation and inability to regulate body temperature are not primary issues associated with edema caused by nephrotic syndrome.

5. A mother has recently been informed that her child has Down syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down syndrome?

• A. Simian crease
• B. Brachycephaly
• C. Oily skin
• D. Hypotonicity

Correct answer: C

Rationale: Individuals with Down syndrome commonly have certain physical characteristics, such as a simian crease (single transverse palmar crease), brachycephaly (shortened front-to-back skull dimension), and hypotonicity (low muscle tone). Oily skin is not a characteristic associated with Down syndrome; instead, individuals with Down syndrome often have dry skin. Therefore, oily skin is the correct answer in this context.

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