Nursing Elites

1. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patient’s electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL per hour. Which action is necessary prior to administering this fluid?

• A. Evaluate the patient’s urine output.
• B. Contact the provider to order arterial blood gases.
• C. Request an order for an initial potassium bolus.
• D. Suggest a diet low in sodium and potassium.

Correct answer: A

Rationale: Prior to administering IV fluids containing potassium, it is crucial to evaluate the patient's urine output. If the urine output is less than 25 mL/hr or 600 mL/day, there is a risk of potassium accumulation. Patients with low urine output should not receive IV potassium to prevent potential complications. Contacting the provider for arterial blood gases is unnecessary in this scenario as it does not directly relate to the administration of IV fluids with potassium. Administering potassium as a bolus is not recommended due to potential adverse effects. While dietary considerations are important, suggesting a low-sodium and low-potassium diet is not the immediate action required before administering IV fluids with potassium chloride.

2. Which of the following lab values would be most concerning in a patient receiving heparin therapy?

• A. Elevated hemoglobin levels.
• B. Low platelet count.
• C. High potassium levels.
• D. Low sodium levels.

Correct answer: B

Rationale: A low platelet count is most concerning in patients receiving heparin therapy due to the risk of heparin-induced thrombocytopenia. Heparin can sometimes cause a drop in platelet count, leading to a potentially serious condition where blood does not clot as it should. This can result in excessive bleeding or clot formation in blood vessels. Elevated hemoglobin levels, high potassium levels, and low sodium levels are not typically associated with heparin therapy and are less likely to cause immediate concerns or complications in this context.

3. Which of the following is a characteristic of chronic obstructive pulmonary disease (COPD)?

• A. Increased lung compliance.
• B. Decreased lung elasticity.
• C. Increased respiratory rate.
• D. Increased lung expansion.

Correct answer: B

Rationale: The correct answer is B: Decreased lung elasticity. Chronic obstructive pulmonary disease (COPD) is characterized by a loss of lung elasticity, which leads to difficulty in exhaling air. This decreased elasticity results in air becoming trapped in the lungs, making it challenging for the individual to breathe effectively. Choice A is incorrect as COPD is associated with decreased lung compliance, not increased compliance. Choice C is incorrect as individuals with COPD often have a decreased respiratory rate due to impaired lung function. Choice D is incorrect as COPD causes limited lung expansion due to factors like air trapping and hyperinflation.

4. When obtaining the health history of a client suspected of having bladder cancer, which question should the nurse ask to determine the client's risk factors?

• A. Do you smoke cigarettes?
• B. Do you consume alcohol?
• C. Do you use recreational drugs?
• D. Do you take any prescription drugs?

Correct answer: A

Rationale: The correct answer is A: 'Do you smoke cigarettes?' Smoking is a major risk factor for bladder cancer. Cigarette smoke contains harmful chemicals that can accumulate in the urine and damage the lining of the bladder, increasing the risk of developing cancer. Alcohol use, recreational drug use, and most prescription drugs are not directly linked to an increased risk of bladder cancer. It is important for the nurse to assess smoking history as a significant risk factor in determining the client's risk for bladder cancer.

5. A client who just returned from the recovery room after a tonsillectomy and adenoidectomy is restless, and her pulse rate is increased. As the nurse continues the assessment, the client begins to vomit a copious amount of bright-red blood. The immediate nursing action is to:

• A. Notify the surgeon
• B. Continue the assessment
• C. Check the client’s blood pressure
• D. Obtain a flashlight, gauze, and a curved hemostat

Correct answer: A

Rationale: In the scenario described, the client's presentation with bright-red blood vomiting after a tonsillectomy and adenoidectomy is highly concerning for an immediate postoperative hemorrhage, which can be life-threatening. The priority action for the nurse is to notify the surgeon immediately. Prompt communication with the surgeon is vital to ensure swift intervention and appropriate management to address the hemorrhage effectively. Continuing the assessment, checking the client's blood pressure, or obtaining equipment are all secondary actions in this critical situation and would delay the necessary urgent intervention required to manage the hemorrhage effectively.

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