Nursing Elites

1. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?

• A. Contact the provider to request an order for serum electrolytes.
• B. Encourage the patient to consume less fluids.
• C. Report symptoms of hyperkalemia to the provider.
• D. Request an order to increase the patient’s potassium dose.

Correct answer: A

Rationale: Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes to assess the patient's potassium levels. Encouraging the patient to consume less fluids would not address the underlying issue of potential hyperkalemia. Reporting symptoms of hyperkalemia to the provider is not as proactive as directly requesting serum electrolytes. Increasing the patient's potassium dose would worsen hyperkalemia, which is already suspected based on the symptoms presented.

2. A client with diabetes mellitus is scheduled to have blood drawn for a fasting blood glucose determination in the morning. What does the nurse tell the client is acceptable to consume on the morning of the test?

• A. Water
• B. Tea without sugar
• C. Coffee without milk
• D. Clear liquids like apple juice

Correct answer: A

Rationale: The correct answer is A: Water. A client scheduled for a fasting blood glucose test should only consume water after midnight to ensure accurate test results. Choosing options B, C, or D, which include tea, coffee, or clear liquids like apple juice, is incorrect as they may contain substances that can affect the blood glucose levels, leading to inaccurate test results.

3. A client in the postanesthesia care unit has an as-needed prescription for ondansetron (Zofran). Which of the following occurrences would prompt the nurse to administer this medication to the client?

• A. Paralytic ileus
• B. Incisional pain
• C. Urine retention
• D. Nausea and vomiting

Correct answer: D

Rationale: The correct answer is D: Nausea and vomiting. Ondansetron is an antiemetic used to manage postoperative nausea and vomiting, as well as nausea and vomiting related to chemotherapy. It is not indicated for treating paralytic ileus, incisional pain, or urine retention. Paralytic ileus is a condition of the gastrointestinal tract characterized by the paralysis of intestinal muscles, which would not be treated with ondansetron. Incisional pain is typically managed with analgesics, not antiemetics. Urine retention is a urinary issue that does not involve nausea and vomiting, making ondansetron an inappropriate choice for this condition.

4. If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:

• A. Explaining how the risk factor behaviors lead to poor health.
• B. Withholding praise until the new behavior is well established.
• C. Rewarding the client whenever the acceptable behavior is performed.
• D. Instilling mild fear in the client to extinguish the behavior.

Correct answer: C

Rationale: The correct answer is C. A fundamental principle of behavior modification is that behavior that is rewarded is more likely to be continued. Therefore, rewarding the client whenever the acceptable behavior is performed is the best approach to reinforce new adaptive behaviors. Choice A is incorrect because simply explaining how the risk factor behaviors lead to poor health may not be as effective in promoting behavior change compared to positive reinforcement. Choice B is incorrect because withholding praise can hinder progress and motivation for the client. Choice D is incorrect because instilling fear is not a recommended method in behavior modification. It can lead to negative psychological effects and is not a sustainable approach to behavior change.

5. A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?

• A. Lymph node involvement is not significant.
• B. Small tumors are aggressive and indicate poor prognosis.
• C. The tumor's estrogen receptor guides treatment options.
• D. Stage I indicates metastasis.

Correct answer: C

Rationale: Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which is one of the most important prognostic factors in early-stage breast cancer.

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