Nursing Elites

1. A nurse is providing discharge instructions to a client following a below-the-knee amputation. Which of the following instructions should the nurse include?

• A. Avoid sitting in a chair for prolonged periods.
• B. Sleep with a pillow under the residual limb.
• C. Elevate the limb continuously for the first 48 hours.
• D. Apply lotion to the residual limb daily.

Correct answer: A

Rationale: The correct answer is to instruct the client to avoid sitting in a chair for prolonged periods. This is important to prevent contractures from developing in the residual limb. Sleeping with a pillow under the residual limb can contribute to contracture formation rather than prevent it. While elevation of the limb is important for reducing swelling and promoting circulation, continuous elevation for 48 hours is not necessary and may not be practical. Applying lotion to the residual limb daily is generally not recommended immediately post-amputation as the wound site needs to heal without interference from lotions or creams.

2. A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose?

• A. 10 mg
• B. 20 mg
• C. 30 mg
• D. 40 mg

Correct answer: B

Rationale: To calculate the correct dose, first, convert the toddler's weight from pounds to kilograms: 22 lb / 2.2 lb/kg = 10 kg. Next, multiply the weight in kilograms by the dosage: 4 mg/kg x 10 kg = 40 mg/day. Since the total daily dose is divided into 2 equal doses, each dose would be 20 mg. Therefore, the correct answer is 20 mg. Choice A (10 mg) is incorrect because it does not account for the correct weight-based dosage. Choice C (30 mg) and Choice D (40 mg) are incorrect as they do not correctly calculate the dose based on the weight of the toddler and the prescribed dosage per kg.

3. A client with burn injuries covering their upper body is concerned about their altered appearance. Which of the following statements should the nurse make?

• A. “It is okay to not want to touch the burned areas of your body.”
• B. “Cosmetic surgery should be performed within the next year to be effective.”
• C. “Reconstructive surgery can completely restore your previous appearance.”
• D. “It could be helpful for you to attend a support group for people who have burn injuries.”

Correct answer: D

Rationale: The nurse should encourage the client to attend a support group for individuals with burn injuries. Support groups can provide emotional support, promote acceptance of altered appearance, and help the client cope with the changes. Choice A is incorrect because it may not address the client's emotional needs. Choice B is incorrect as suggesting a timeline for cosmetic surgery may not be appropriate without considering the client's physical and emotional readiness. Choice C is incorrect as reconstructive surgery may not completely restore the client's previous appearance and may set unrealistic expectations.

4. A nurse is caring for a client who has severe preeclampsia and is receiving magnesium sulfate. The nurse should monitor the client for which of the following findings as an indication of magnesium toxicity?

• A. Decreased deep tendon reflexes
• B. Elevated blood pressure
• C. Increased urinary output
• D. Hyperreflexia

Correct answer: A

Rationale: The correct answer is A: Decreased deep tendon reflexes. Magnesium sulfate toxicity can lead to diminished deep tendon reflexes, respiratory depression, and decreased urine output. Diminished deep tendon reflexes are an early sign of magnesium toxicity and indicate the need to discontinue the infusion. Elevated blood pressure (choice B) is not typically associated with magnesium toxicity. Increased urinary output (choice C) is also not a common finding in magnesium toxicity. Hyperreflexia (choice D) is not consistent with the expected findings of magnesium toxicity, which typically causes decreased reflexes.

5. A nurse is caring for a client who is receiving oxytocin to augment labor. The nurse notes recurrent variable decelerations of the FHR. Which of the following actions should the nurse take first?

• A. Prepare the equipment necessary to initiate an amnioinfusion
• B. Administer oxygen at 10 L/min via a non-rebreather face mask
• C. Discontinue the infusion of oxytocin
• D. Place the client in a left lateral position

Correct answer: C

Rationale: The correct first action for the nurse to take is to discontinue the infusion of oxytocin. Oxytocin can lead to uterine hyperstimulation and fetal distress, contributing to variable decelerations in fetal heart rate. By stopping the oxytocin infusion, the nurse can promptly assess and manage the fetal heart rate. Choice A, preparing for amnioinfusion, is not the priority when faced with recurrent variable decelerations. Choice B, administering oxygen, is important but addressing the oxytocin infusion issue takes precedence. Choice D, placing the client in a left lateral position, is beneficial for optimizing fetal oxygenation but discontinuing oxytocin is the initial step in managing variable decelerations.

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