Nursing Elites

1. The nurse is monitoring a client with chronic renal failure who is receiving hemodialysis. The nurse should report which of the following findings immediately?

• A. Clear dialysate outflow.
• B. Weight gain of 2 lbs (0.9 kg) since the last treatment.
• C. Blood pressure of 130/80 mm Hg.
• D. Pulse rate of 72 bpm.

Correct answer: B

Rationale: The correct answer is B. Weight gain of 2 lbs (0.9 kg) since the last treatment is concerning in a client undergoing hemodialysis with chronic renal failure as it may indicate fluid overload. This finding requires immediate reporting and intervention to prevent complications such as fluid retention, pulmonary edema, or exacerbation of heart failure. Choices A, C, and D are not findings that require immediate attention in this context. Clear dialysate outflow is a normal finding during hemodialysis, a blood pressure of 130/80 mm Hg is within a normal range for many clients, and a pulse rate of 72 bpm is also within the expected range for most individuals.

2. A client with gouty arthritis reports tenderness and swelling of the right ankle and great toe. The nurse observes the area of inflammation extends above the ankle. The client receives prescriptions for colchicine and indomethacin. Which instruction should the nurse include in the discharge teaching?

• A. Eat high-protein foods to achieve ideal body weight
• B. Drink at least 8 cups (1920mL) of water per day
• C. Use an electric heating pad when pain is at its worst
• D. Encourage active range of motion to prevent stiffness

Correct answer: B

Rationale: The correct answer is to instruct the client to drink at least 8 cups (1920mL) of water per day. Adequate hydration helps to prevent the formation of uric acid crystals, which can exacerbate gout symptoms. Choice A is incorrect because while maintaining a healthy weight is important, it doesn't directly address gout management. Choice C is incorrect because using an electric heating pad can worsen inflammation. Choice D is incorrect because active range of motion may exacerbate pain and inflammation in the affected joints.

3. A client is placed on a mechanical ventilator following a cerebral hemorrhage, and vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed. What is the priority nursing diagnosis for this client?

• A. Impaired communication related to paralysis of skeletal muscles.
• B. High risk for infection related to increased intracranial pressure.
• C. Potential for injury related to impaired lung expansion.
• D. Social isolation related to inability to communicate.

Correct answer: A

Rationale: The priority nursing diagnosis for a client on a mechanical ventilator receiving vecuronium bromide is 'Impaired communication related to paralysis of skeletal muscles.' Vecuronium is a skeletal muscle relaxant that causes diaphragmatic paralysis, leading to the inability of the client to communicate effectively. This is a crucial nursing concern as it impacts the client's ability to express needs and participate in care. Option B 'High risk for infection related to increased intracranial pressure' is not the priority in this scenario as the client's condition is related to the effects of the medication and mechanical ventilation, not directly to increased intracranial pressure. Option C 'Potential for injury related to impaired lung expansion' is important but not the priority over impaired communication. Option D 'Social isolation related to inability to communicate' is not the priority nursing diagnosis in this situation as it focuses more on psychosocial aspects rather than the immediate physiological concern of communication impairment.

4. Four hours following surgical repair of a compound fracture of the right ulna, the nurse is unable to palpate the client's right radial pulse. Which action should the nurse take first?

• A. Notify the healthcare provider of the finding immediately.
• B. Complete a neurovascular assessment of the right hand.
• C. Elevate the client's right hand on one or two pillows.
• D. Measure the client's blood pressure and apical pulse rate.

Correct answer: B

Rationale: Completing a neurovascular assessment of the right hand is the priority in this situation. This assessment will help determine the circulation, sensation, and movement of the affected limb, ensuring there are no complications like compartment syndrome or impaired perfusion. Notifying the healthcare provider immediately (Choice A) might be necessary but should come after assessing the client's neurovascular status. Elevating the client's right hand (Choice C) can be helpful in some cases but should not precede a neurovascular assessment. Measuring the client's blood pressure and apical pulse rate (Choice D) is important but not the priority when assessing a potential vascular compromise in the limb.

5. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?

• A. A serum drug level greater than the MEC ensures that the drug is bacteriostatic.
• B. A serum drug level greater than the MEC broadens the spectrum of the drug.
• C. A serum drug level greater than the MEC helps eradicate bacterial infections.
• D. A serum drug level greater than the MEC increases the therapeutic index.

Correct answer: C

Rationale: The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Therefore, choice A is incorrect. Broadening the spectrum of a drug refers to its range of activity against different microorganisms, which is not directly related to MEC. Thus, choice B is incorrect. Increasing the therapeutic index involves maximizing the effectiveness of a drug while minimizing its toxicity, which is not specifically related to MEC. Therefore, choice D is also incorrect.

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