Nursing Elites

1. A nurse is preparing to administer medications to a client who has a nasogastric (NG) tube. Which of the following actions should the nurse take first?

• A. Check for tube placement.
• B. Flush the NG tube with 0.9% sodium chloride.
• C. Administer the medications as a bolus.
• D. Dissolve the medications in 30 mL of sterile water.

Correct answer: A

Rationale: The correct first action for the nurse to take when preparing to administer medications to a client with a nasogastric (NG) tube is to check for tube placement. This step is crucial to ensure that the NG tube is correctly positioned in the stomach and not in the respiratory tract, reducing the risk of aspiration. Flushing the NG tube with 0.9% sodium chloride, administering the medications as a bolus, or dissolving the medications in sterile water should only be done after confirming the proper placement of the NG tube. Therefore, options B, C, and D are incorrect as they precede the essential step of verifying tube placement.

2. A nurse is assessing a client who is 48 hours postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?

• A. Serosanguineous drainage on the surgical dressing.
• B. Temperature of 37.8°C (100°F).
• C. Urine output of 75 mL in the past 4 hours.
• D. WBC count of 15,000/mm³.

Correct answer: D

Rationale: The correct answer is D. An elevated WBC count can indicate a potential infection, especially in a postoperative client. This finding should be reported to the provider for further evaluation and management. Choices A, B, and C are common occurrences in postoperative clients and may not necessarily indicate a severe issue. Serosanguineous drainage on the surgical dressing is a normal finding in the immediate postoperative period. A temperature of 37.8°C (100°F) can be a mild fever, which is common postoperatively due to the body's response to tissue injury. Urine output of 75 mL in the past 4 hours may be within normal limits for a postoperative client, especially if they are still recovering from anesthesia.

3. A nurse is providing teaching to a client who has a new prescription for digoxin. Which of the following instructions should the nurse include?

• A. Avoid taking this medication with antacids.
• B. Contact your provider if you experience visual changes.
• C. Increase your intake of foods high in potassium.
• D. You may experience increased urination while taking this medication.

Correct answer: B

Rationale: The correct answer is B: 'Contact your provider if you experience visual changes.' Visual changes, such as blurred or yellow vision, can indicate digoxin toxicity and should be reported immediately to the healthcare provider for further evaluation and management. Choice A is incorrect because digoxin can be taken with antacids. Choice C is incorrect because increasing potassium intake can lead to hyperkalemia when taking digoxin. Choice D is incorrect because increased urination is not a common side effect of digoxin.

4. A nurse is preparing to administer blood to a client. Which of the following actions should the nurse take first?

• A. Check the client's identification bracelet.
• B. Obtain the client's vital signs.
• C. Initiate the transfusion slowly over the first 15 minutes.
• D. Verify the client's blood type and Rh factor.

Correct answer: D

Rationale: The correct answer is to verify the client's blood type and Rh factor first before administering blood. This is crucial to ensure compatibility and prevent transfusion reactions. Checking the client's identification bracelet (Choice A) is important but should come after verifying blood type. Obtaining vital signs (Choice B) and initiating the transfusion slowly (Choice C) are important steps but verifying blood type is the priority to ensure safe blood administration.

5. A healthcare provider is planning to delegate client assignments to the assistive personnel. Which of the following tasks is appropriate for the healthcare provider to delegate?

• A. Adjusting the flow rate of the client's oxygen tank.
• B. Collecting a urine sample.
• C. Measuring the client's pain level.
• D. Transporting a client to x-ray.

Correct answer: D

Rationale: The correct answer is 'D: Transporting a client to x-ray.' This task is appropriate for delegation to assistive personnel as it involves transferring the client safely from one location to another, which does not require the specialized skills of a healthcare provider. Adjusting the flow rate of the client's oxygen tank (Choice A) involves making clinical decisions that should be done by a licensed healthcare provider. Collecting a urine sample (Choice B) and measuring the client's pain level (Choice C) require critical thinking and assessment skills that are typically within the scope of practice of licensed healthcare providers, not assistive personnel.

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