Nursing Elites

1. A nurse is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?

• A. BUN 8 mg/dL
• B. Hgb 15 g/dL
• C. Creatinine 0.8 mg/dL
• D. Sodium 140 mEq/L

Correct answer: A

Rationale: A BUN level of 8 mg/dL is indicative of fluid volume excess, which is common in clients with heart failure.

2. A nurse is caring for a client with a major burn injury and is receiving TPN. Which of the following lab tests is the priority for the nurse to use to confirm the client is receiving adequate nutrition?

• A. Iron
• B. Magnesium
• C. Folic acid
• D. Prealbumin

Correct answer: D

Rationale: Prealbumin is a sensitive indicator of protein status and nutrition, making it a priority for assessing nutritional adequacy in clients receiving TPN.

3. A nurse is caring for a client who is receiving a continuous enteral tube feeding and reports cramping and abdominal distention. Which of the following actions should the nurse take?

• A. Check for gastric residual.
• B. Apply low intermittent suction.
• C. Increase the rate of the feeding.
• D. Request a higher-fat formula.

Correct answer: A

Rationale: Checking for gastric residual can help identify the cause of cramping and abdominal distention during enteral feedings.

4. A nurse is teaching a client about strategies to prevent constipation. Which of the following statements by the client indicates an understanding of the teaching?

• A. Drinking four to five glasses of water per day will prevent constipation.
• B. I should consume mineral oil once per day.
• C. Eating foods high in fiber will make elimination easier.
• D. I can skip a meal if I feel bloated.

Correct answer: C

Rationale: Eating foods high in fiber increases stool bulk and promotes easier elimination, thus preventing constipation.

5. A nurse is caring for a client who has a small-bore jejunostomy and is receiving a continuous tube feeding with a high-viscosity formula. Which of the following actions should the nurse take to prevent the tubing from clogging?

• A. Replace the bag and tubing every 24 hr
• B. Flush the tubing with 10 mL water every 6 hr
• C. Admin the feeding by gravity drip
• D. Heat the formula prior to infusion

Correct answer: B

Rationale: Flushing the tubing with 10 mL of water every 6 hours helps prevent clogging when using high-viscosity formulas.

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