Nursing Elites

1. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?

• A. Use the catheter for the next laboratory blood draw.
• B. Monitor the central venous pressure through this line.
• C. Access the line for the next intravenous medication.
• D. Place a heparin or heparin/saline dwell after hemodialysis.

Correct answer: D

Rationale: The most appropriate action for the nurse after a central line catheter placement for hemodialysis is to place a heparin or heparin/saline dwell after hemodialysis treatment. This helps prevent clot formation in the line and maintain patency for future use. Using the catheter for blood draws is not recommended as it may increase the risk of infection. Monitoring central venous pressure is not indicated with this type of catheter. Accessing the line for medications is also not recommended to prevent complications and ensure the line is solely used for hemodialysis purposes.

2. The nurse is preparing to begin a medication regimen for a patient who will receive intravenous ampicillin and gentamicin. Which is an important nursing action?

• A. Administer each antibiotic to infuse over 15 to 20 minutes.
• B. Order serum peak and trough levels of ampicillin.
• C. Prepare the schedule so that the drugs are given at the same time.
• D. Set up separate tubing sets for each drug labeled with the drug name and date.

Correct answer: D

Rationale: When administering intravenous aminoglycosides like gentamicin with penicillins such as ampicillin, it is crucial to avoid mixing them in the same container. Separate tubing sets labeled with the drug name and date should be used to prevent interactions between the medications. Administering each antibiotic over 15 to 20 minutes (Choice A) may not be appropriate for all medications and does not address the issue of compatibility. Ordering serum peak and trough levels of ampicillin (Choice B) is important for monitoring drug levels but does not directly address the administration process. Preparing a schedule to give drugs simultaneously (Choice C) may increase the risk of drug interactions and is not recommended when administering incompatible medications.

3. Which of the following is a common cause of chronic liver disease?

• A. Alcohol abuse.
• B. Hepatitis C infection.
• C. Obesity.
• D. Smoking.

Correct answer: B

Rationale: Hepatitis C infection is a common cause of chronic liver disease due to its long-term effects on the liver. Hepatitis C can lead to liver inflammation, fibrosis, cirrhosis, and even liver cancer. Alcohol abuse can also cause liver damage, but hepatitis C infection is specifically known for its chronic impact on liver health. Obesity and smoking, while detrimental to overall health, are not typically direct causes of chronic liver disease like hepatitis C infection.

4. A client is unsure of the decision to undergo peritoneal dialysis (PD) and wishes to discuss the advantages of this treatment with the nurse. Which statements by the nurse are accurate regarding PD? (Select all that apply.)

• A. You will not need vascular access to perform PD.
• B. There is less restriction of protein and fluids.
• C. You have flexible scheduling for the exchanges.
• D. All of the above

Correct answer: D

Rationale: The correct answer is D, as all the statements are accurate advantages of peritoneal dialysis (PD). Peritoneal dialysis does not require vascular access, offers less restriction on protein and fluids, and provides flexibility in scheduling for the exchanges. Choice A is correct because one of the advantages of PD is not needing vascular access, which is required in hemodialysis. Choice B is correct because PD allows for less dietary restriction compared to hemodialysis. Choice C is correct because PD allows for flexible scheduling of exchanges, providing more independence to the individual undergoing treatment.

5. The patient is being educated on taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?

• A. I may need additional sodium and calcium while taking this medication.
• B. I should consume plenty of fruits and vegetables while taking this drug.
• C. I should be cautious when getting up from a bed or chair while on this medication.
• D. I will take the medication in the morning to reduce certain side effects.

Correct answer: A

Rationale: The correct answer is A because patients do not require extra sodium or calcium while taking hydrochlorothiazide, a thiazide diuretic. This medication actually promotes the excretion of sodium and water. Choices B, C, and D are correct statements regarding the use of hydrochlorothiazide. Patients are encouraged to have a diet rich in fruits and vegetables, be careful with position changes due to potential orthostatic hypotension, and take the medication in the morning to reduce the need for frequent urination during nighttime.

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