Nursing Elites

1. You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patients skin turgor?

• A. Overhydration is common among healthy older adults.
• B. Dehydration causes the skin to appear spongy
• C. Inelastic skin turgor is a normal part of aging
• D. Skin turgor cannot be assessed in patients over 70.

Correct answer: C

Rationale:

2. A nurse is caring for a client with a peripheral vascular access device who is experiencing pain, redness, and swelling at the site. After removing the device, which action should the nurse take to relieve pain?

• A. Administer topical lidocaine to the site.
• B. Place warm compresses on the site.
• C. . Administer prescribed oral pain medication.
• D. Massage the site with scented oils.

Correct answer: B

Rationale:

3. What happens first in dehydration?

• A. Intercellular fluid volume drops first.
• B. Plasma volume drops first.
• C. Interstitial fluid drops first.
• D. Neither interstitial nor intracellular fluid volume are affected.

Correct answer: C

Rationale: In dehydration, the body first draws fluid from the interstitial space to maintain blood volume, leading to a decrease in interstitial fluid volume. This is why choice C is correct. Choice A is incorrect because intracellular fluid is not the first to be affected. Choice B is also incorrect as plasma volume reduction typically occurs after interstitial fluid loss. Choice D is incorrect as dehydration impacts both interstitial and intracellular fluid volumes.

4. The patient asks the nurse if he will die if air bubbles get into the IV tubing. What is the nurse's best response?

• A. The system is closed, and that scenario is highly unlikely.
• B. Only relatively large volumes of air administered rapidly are dangerous.
• C. There is a risk of complications associated with IV administration.
• D. You have been influenced by movies too much.

Correct answer: B

Rationale: The correct answer is B because air emboli are more commonly associated with central vein access. Usually, only relatively large volumes of air administered rapidly are dangerous. It is a significant concern when air enters a central venous access line. Choice A is incorrect as it downplays the risk and is not entirely accurate. Choice C is too general and does not specifically address the patient's concern. Choice D is dismissive and does not provide any relevant information regarding the risk of air bubbles in IV tubing.

5. A patient's lab results show a slight decrease in potassium. The physician has declined to treat with drug therapy but has suggested increasing the potassium through diet. Which of the following would be a good source of potassium?

• A. Apples
• B. Asparagus
• C. Carrots
• D. Bananas

Correct answer: D

Rationale: Bananas are an excellent source of potassium, making them a good choice to increase potassium levels through diet. While apples, asparagus, and carrots are nutritious, they are not particularly high in potassium compared to bananas. Therefore, choosing bananas would be more effective in increasing the patient's potassium intake.

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