Nursing Elites

1. When administering intravenous electrolyte solution, what precaution should the nurse take?

• A. Infuse hypertonic solutions cautiously.
• B. Mix no more than 60 mEq of potassium per liter of fluid.
• C. Prevent infiltration of calcium, which causes tissue necrosis and sloughing.
• D. Monitor the client's digitalis dosage for adjustments due to IV calcium.

Correct answer: C

Rationale: When administering intravenous electrolyte solutions, preventing the infiltration of calcium is crucial to avoid tissue necrosis and sloughing, making choice C the correct answer. Choice A is revised to 'Infuse hypertonic solutions cautiously' because hypertonic solutions should be infused cautiously to prevent adverse effects. Choice B is corrected to 'Mix no more than 60 mEq of potassium per liter of fluid' as exceeding this limit can lead to hyperkalemia. Choice D is modified to 'Monitor the client's digitalis dosage for adjustments due to IV calcium' as it is essential to monitor the digitalis dosage for potential adjustments when IV calcium is administered; however, this choice is incorrect here as it inaccurately suggests adjusting the digitalis dosage due to IV calcium, which could lead to harmful effects.

2. The nurse is caring for a burn victim with a skin graft to the hand. The area is pale and mottled but has good capillary refill. What is the nurse's best action at this time?

• A. Warm the room
• B. Submerge the hand in warm water
• C. Order a K pad and apply to hand
• D. Have the client exercise the fingers to increase blood flow

Correct answer: A

Rationale: The correct action for the nurse to take when caring for a burn victim with a skin graft to the hand, exhibiting pale and mottled skin but good capillary refill, is to warm the room. By warming the room, the nurse helps promote circulation and maintain a conducive environment for healing. Submerging the hand in warm water can pose a risk of injury or infection to the graft site. Ordering a K pad and applying it to the hand may not be necessary at this time and could potentially cause harm. Having the client exercise the fingers to increase blood flow is also not recommended as it may interfere with the healing process of the skin graft.

3. A patient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patient's lower extremity. Which of the following is the most probable result of the fall?

• A. Peroneal nerve injury
• B. Tibial nerve injury
• C. Sciatic nerve injury
• D. Femoral nerve injury

Correct answer: A

Rationale: The correct answer is peroneal nerve injury. The head of the proximal fibula is in close proximity to the peroneal nerve, making it susceptible to injury when there is a fracture. The peroneal nerve runs along the fibula and can be affected by trauma to this area. Choice B, tibial nerve injury, is incorrect as the fracture site is closer to the peroneal nerve, not the tibial nerve. Choice C, sciatic nerve injury, is incorrect as the injury is more localized to the fibular head area where the peroneal nerve is affected. Choice D, femoral nerve injury, is incorrect as the femoral nerve is not immediately adjacent to the proximal fibula and is not typically affected by this type of injury.

4. The client is preparing to undergo a total hysterectomy for advanced cervical cancer. The client is crying and says that she wants to have more children and is unsure if she should have the procedure. What should the nurse do?

• A. Allow the client to honestly discuss her fears and encourage her to talk more with her physician.
• B. Tell her the good things that she will be able to do without more children and encourage her to make a list of positive things.
• C. Explain to the client that her ovaries can be frozen for egg harvesting at a later time and she can find a surrogate.
• D. Advise the client to put off having the surgery until she is sure that she wants to undergo the procedure and notify the surgeon of the decision.

Correct answer: A

Rationale: In this situation, the most appropriate action for the nurse is to allow the client to express her fears and concerns openly. By encouraging her to talk more with her physician, the nurse is promoting effective communication and ensuring that the client receives adequate information to make an informed decision. Option A is correct because it acknowledges the client's emotions and empowers her to seek clarification and support from her healthcare provider. Options B and C do not address the client's emotional needs or provide a solution to her concerns regarding fertility. Option D is not appropriate as it does not prioritize the client's emotional well-being and delays necessary medical treatment for advanced cervical cancer.

5. Which factor in a client’s health history increases their risk for cancer?

• A. Family history and environment
• B. Alcohol and smoking
• C. Alcohol consumption and smoking
• D. Proximity to an electric plant and water source

Correct answer: B

Rationale: The correct answer is 'Alcohol and smoking.' Both alcohol consumption and smoking are well-known risk factors for various types of cancer. They have a synergistic effect, meaning their combined impact raises the risk significantly. Family history and environment (Choice A) may play a role in certain cancers, but alcohol and smoking are more directly linked to increased cancer risk. Proximity to an electric plant and water source (Choice D) is not typically associated with an increased risk of cancer compared to alcohol and smoking.

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