Nursing Elites

1. Which of the following is an inappropriate item to include in planning care for a severely neutropenic client?

• A. Transfuse neutrophils (granulocytes) to prevent infection.
• B. Exclude raw vegetables from the diet.
• C. Avoid administering rectal suppositories.
• D. Prohibit vases of fresh flowers and plants in the client's room.

Correct answer: A

Rationale: The correct answer is to transfuse neutrophils (granulocytes) to prevent infection. Granulocyte transfusion is not routinely indicated to prevent infection in neutropenic clients. While neutrophils are essential in fighting infections and are beneficial in selected populations of infected, severely granulocytopenic clients who do not respond to antibiotics and are expected to experience prolonged suppression of granulocyte production, routine granulocyte transfusion is not recommended. Choices B, C, and D are appropriate interventions for a severely neutropenic client. Prohibiting fresh flowers and plants helps reduce the risk of exposure to environmental pathogens. Avoiding rectal suppositories minimizes the risk of introducing harmful bacteria. Excluding raw vegetables from the diet reduces the likelihood of foodborne infections.

2. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:

• A. a maintenance dose.
• B. a loading dose.
• C. a medication with no first-pass effect.
• D. the medication to be given intravenously.

Correct answer: B

Rationale: To rapidly achieve a therapeutic plasma drug concentration, a loading or priming dose is ordered. This dose quickly establishes the desired drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. A maintenance dose, like choice A, is used to maintain the therapeutic level after the loading dose. Waiting for steady state without a loading dose would take five drug half-lives. Choice C, a medication with no first-pass effect, does not directly address the need for rapid attainment of therapeutic levels. While intravenous administration (choice D) offers excellent bioavailability, a single dose by this route may not achieve the desired therapeutic plasma concentration as rapidly as a loading dose.

3. When administering intravenous electrolyte solution, which of the following precautions 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 potential adjustments due to IV calcium administration.

Correct answer: C

Rationale: When administering intravenous electrolyte solutions, it is crucial to prevent infiltration of calcium to avoid tissue necrosis and sloughing. Hypertonic solutions should be infused cautiously (Choice A) to prevent adverse effects. The correct amount of potassium to be mixed in a liter of fluid is no more than 60 mEq, making Choice B incorrect. While monitoring the client's digitalis dosage for potential adjustments due to IV calcium administration is important, the statement suggesting an increased dosage is incorrect as IV calcium diminishes digitalis's action, making Choice D incorrect.

4. What type of diet is appropriate for a client with chronic cirrhosis?

• A. High calorie, low protein
• B. High protein, high calorie
• C. Low fat, low sodium
• D. High calorie, low sodium

Correct answer: A

Rationale: The correct diet for a client with chronic cirrhosis is high calorie, low protein. Cirrhosis can lead to impaired protein metabolism, making it essential to limit protein intake. High-calorie foods help meet the client's energy needs. Choice B (High protein, high calorie) is incorrect because high protein intake can worsen hepatic encephalopathy. Choice C (Low fat, low sodium) is not the most appropriate diet for cirrhosis as the focus should be on calories and protein. Choice D (High calorie, low sodium) does not address the need to restrict protein intake, which is crucial in cirrhosis.

5. A 13-year-old girl is admitted to the ER with lower right abdominal discomfort. What should the admitting nurse do first?

• A. Administer Loritab to the patient for pain relief.
• B. Place the patient in a right sidelying position for pressure relief.
• C. Start a Central Line.
• D. Provide pain reduction techniques without administering medication.

Correct answer: D

Rationale: In a case of lower right abdominal discomfort, the first step should be to provide pain reduction techniques without administering medication. Administering pain medication or starting a central line should not be done without medical orders. Placing the patient in a right sidelying position may help with pressure relief, but addressing pain reduction techniques without medication is the initial priority in this scenario. It is essential to assess the patient further, consult with a healthcare provider, and follow the appropriate protocols before administering any medication or invasive procedures like starting a central line.

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