Nursing Elites

1. At 1200, the practical nurse learns that a client's 0900 dose of an anticonvulsant was not given. The next scheduled dose is at 2100. Which action should the PN take?

• A. Administer half of the missed dose immediately
• B. Administer the missed dose as soon as possible
• C. Give the missed dose with the next scheduled dose
• D. Withhold the missed dose unless seizure activity occurs

Correct answer: B

Rationale: Administering the missed dose as soon as possible is crucial in this situation. Missing an anticonvulsant dose can lead to breakthrough seizures, which are harmful to the client. Administering the missed dose promptly helps maintain the therapeutic level of the medication and reduces the risk of seizure activity. Giving half the dose may not provide adequate protection against seizures. Delaying the dose until the next scheduled time increases the time the client is without the medication, potentially increasing the risk of seizures. Withholding the missed dose unless seizure activity occurs is not recommended, as prevention is key in managing anticonvulsant therapy.

2. Which is the most important safety measure when administering a medication through a patient’s central venous catheter (CVC)?

• A. Using a sterile technique
• B. Ensuring correct placement of the CVC
• C. Flushing the CVC with saline after administration
• D. Monitoring for signs of infection

Correct answer: B

Rationale: The most important safety measure when administering a medication through a patient’s central venous catheter (CVC) is ensuring the correct placement of the CVC. This is crucial to prevent complications such as extravasation, infection, or improper drug delivery. While using a sterile technique, flushing the CVC with saline after administration, and monitoring for signs of infection are all important aspects of CVC care, ensuring the correct placement of the catheter takes precedence as it directly impacts patient safety during medication administration.

3. The practical nurse is caring for a client who had a total laryngectomy, left radical neck dissection, and tracheostomy. The client is receiving nasogastric tube feedings via an enteral pump. Today the rate of feeding is increased from 50 ml/hr to 75 ml/hr. What parameter should the PN use to evaluate the client's tolerance to the rate of the feeding?

• A. Daily weight
• B. Gastric residual volumes
• C. Bowel sounds
• D. Urinary and stool output

Correct answer: B

Rationale: Monitoring gastric residual volumes helps to assess how well the client is tolerating the increased feeding rate. High residuals may indicate delayed gastric emptying, which could lead to complications like aspiration. This helps in adjusting the feeding plan as necessary. Daily weight (Choice A) is not the most appropriate parameter to evaluate tolerance to feeding rate changes. Bowel sounds (Choice C) and urinary/stool output (Choice D) are important assessments but do not directly indicate tolerance to enteral feeding rate changes.

4. When caring for a child with sickle cell disease, the PN expects that the child will most likely describe which symptom when experiencing a sickle cell crisis?

• A. Decreased hemoglobin
• B. Joint pain
• C. Fatigue
• D. Infection

Correct answer: B

Rationale: During a sickle cell crisis, a child with sickle cell disease is most likely to describe joint pain. Sickle cell disease leads to the blockage of blood flow by sickled red blood cells, causing ischemia and pain, often felt in the joints and other body parts. Fatigue (choice C) is a nonspecific symptom that can occur in various conditions but is not a characteristic symptom of a sickle cell crisis. While decreased hemoglobin (choice A) can be observed in sickle cell disease, it is not a symptom typically described by a child during a sickle cell crisis. Infection (choice D) can trigger a sickle cell crisis but is not the symptom most likely to be described by the child during the crisis.

5. After spinal fusion surgery, a client reports numbness and tingling in the legs. What should the nurse do first?

• A. Assess the client’s neurovascular status in the lower extremities.
• B. Reposition the client to relieve pressure on the spine.
• C. Administer prescribed pain medication.
• D. Notify the healthcare provider immediately.

Correct answer: A

Rationale: After spinal fusion surgery, numbness and tingling in the legs may indicate nerve compression or damage. The priority action for the nurse is to assess the client’s neurovascular status in the lower extremities. This assessment will help determine the cause and severity of the symptoms, guiding further interventions. Repositioning the client may be necessary for comfort, but assessing neurovascular status is the initial step. Administering pain medication should only follow the assessment to address any discomfort. Notifying the healthcare provider immediately is not the first action unless there are emergent signs requiring urgent intervention.

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