Nursing Elites

1. The nurse is preparing to insert a peripheral IV catheter into a patient who will require fluids and IV antibiotics. How should the nurse always start the process of insertion?

• A. Leave one hand ungloved to assess the site.
• B. Cleanse the skin with normal saline.
• C. Ask the patient about allergies to latex or iodine.
• D. Remove excessive hair from the selected site.

Correct answer: Ask the patient about allergies to latex or iodine.

Rationale:

2. After providing discharge teaching, a nurse assesses the clients understanding regarding increased risk for metabolic alkalosis. Which statement indicates the client needs additional teaching?

• A. . I dont drink milk because it gives me gas and diarrhea
• B. I have been taking digoxin every day for the last 15 years
• C. . I take sodium bicarbonate after every meal to prevent heartburn
• D. In hot weather, I sweat so much that I drink six glasses of water each day.

Correct answer: . I take sodium bicarbonate after every meal to prevent heartburn

Rationale:

3. Which of the following is not considered an extracellular fluid?

• A. Cerebrospinal fluid
• B. The humors of the eye
• C. Lymph
• D. Cerebrospinal fluid and the humors of the eye

Correct answer: D

Rationale: The correct answer is D. Cerebrospinal fluid and the humors of the eye are not considered extracellular fluids. Extracellular fluids are fluids found outside the cells, such as interstitial fluid and lymph. Cerebrospinal fluid is found within the central nervous system, while the humors of the eye (aqueous humor and vitreous humor) are located within the eyeball, making them distinct from extracellular fluids.

4. While assessing a clients peripheral IV site, the nurse observes a streak of red along the vein path and palpates a 4-cm venous cord. How should the nurse document this finding?

• A. Grade 3 phlebitis at IV site
• B. infection at IV site
• C. Thrombosed area at IV site
• D. infiltration at IV site

Correct answer: Grade 3 phlebitis at IV site

Rationale:

5. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?

• A. Hypertension
• B. Kussmaul respirations
• C. Increased DTRs
• D. Shallow respirations

Correct answer: Shallow respirations

Rationale:

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