Nursing Elites

1. When teaching a client how to administer medication through a jejunostomy tube, which of the following instructions should the nurse include?

• A. Flush the tube before and after each medication.
• B. Mix medications with enteral feeding.
• C. Push tablets through the tube slowly.
• D. Mix crushed medications before dissolving them in water.

Correct answer: A

Rationale: The correct answer is to flush the tube before and after each medication administration. This helps prevent clogging and ensures the medication is delivered properly. Mixing medications with enteral feeding (choice B) is incorrect as medications should be administered separately. Pushing tablets through the tube (choice C) is not recommended as they should be properly dissolved before administration. Mixing all crushed medications before dissolving them in water (choice D) is incorrect; medications should be dissolved individually to avoid interactions or inconsistencies in dosages.

2. A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory value should the LPN/LVN monitor to determine the effectiveness of this medication?

• A. Serum potassium
• B. Hemoglobin
• C. Serum creatinine
• D. Blood urea nitrogen (BUN)

Correct answer: B

Rationale: The correct answer is B: Hemoglobin. Monitoring hemoglobin levels is essential to assess the effectiveness of epoetin alfa in clients with chronic kidney disease. Epoetin alfa is a medication that stimulates red blood cell production, aiming to increase hemoglobin levels and improve symptoms of anemia in these patients. Monitoring serum potassium (Choice A) is important in clients with kidney disease, but it is more related to assessing electrolyte balance rather than the direct effectiveness of epoetin alfa. Serum creatinine (Choice C) and blood urea nitrogen (Choice D) are kidney function tests that help evaluate kidney health but do not specifically reflect the effectiveness of epoetin alfa therapy.

3. UAP has lowered the head of the bed to change the linens for a client who is bedridden. Which observation...most immediate intervention by the nurse?

• A. A feeding is infusing at 40 mL/hr through an enteral feeding tube.
• B. The urine meter attached to the urinary drainage bag is completely full.
• C. There is a large dependent loop in the client's urinary drainage tubing.
• D. Purulent drainage is present around the insertion site of the feeding tube.

Correct answer: D

Rationale: The correct answer is D. Purulent drainage around the insertion site of the feeding tube indicates an infection, which requires immediate attention. This may be a sign of a serious complication that needs prompt nursing intervention to prevent further complications or deterioration in the client's condition. Choices A, B, and C do not indicate an immediate threat to the client's health. While option A highlights the infusion rate of the feeding, it does not pose an immediate risk compared to the presence of purulent drainage indicating infection.

4. A healthcare provider is assessing a client with a diagnosis of acute pancreatitis. Which laboratory value would be most concerning?

• A. Serum amylase of 200 U/L
• B. Serum lipase of 250 U/L
• C. Blood glucose of 200 mg/dL
• D. Serum calcium of 7.5 mg/dL

Correct answer: D

Rationale: In acute pancreatitis, hypocalcemia (low serum calcium) is a critical finding that is associated with a poor prognosis and requires immediate attention. Serum amylase and lipase are typically elevated in acute pancreatitis due to pancreatic inflammation, but they are not indicators of severity. Blood glucose levels may be elevated due to stress or underlying conditions but are not directly related to the severity of acute pancreatitis. Therefore, the most concerning value in this scenario is the low serum calcium level, which can have significant implications for the client's prognosis.

5. A client with a history of atrial fibrillation is receiving warfarin (Coumadin). Which laboratory value should the LPN/LVN monitor closely while the client is taking this medication?

• A. Blood glucose level
• B. Prothrombin time (PT) and INR
• C. Serum potassium level
• D. Serum creatinine level

Correct answer: B

Rationale: The LPN/LVN should closely monitor Prothrombin time (PT) and INR (Choice B) levels in a client receiving warfarin. These values are crucial to ensure the medication's effectiveness and prevent complications like bleeding. Monitoring blood glucose level (Choice A) is not directly relevant to warfarin therapy. While serum potassium level (Choice C) and serum creatinine level (Choice D) are important for other conditions or medications, they are not specifically required to be monitored when a client is on warfarin.

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