Nursing Elites

1. Before administering an antibiotic that can cause nephrotoxicity, which lab value is most important for the PN to review?

• A. Hemoglobin and Hematocrit
• B. Serum Calcium
• C. Serum Creatinine
• D. WBC

Correct answer: C

Rationale: Serum creatinine is the most important lab value to review before administering an antibiotic that can cause nephrotoxicity. This is because serum creatinine is a key indicator of kidney function. An elevated serum creatinine level may indicate impaired renal function, and administering nephrotoxic drugs in such situations can further damage the kidneys. Monitoring serum creatinine levels helps healthcare providers assess renal function and make informed decisions regarding drug administration. Choices A, B, and D are not as directly related to kidney function and nephrotoxicity, making them less crucial in this scenario. Hemoglobin and hematocrit levels assess for anemia, serum calcium levels are more related to bone health and nerve function, and WBC count is associated with immune response, none of which directly reflect kidney function or the risk of nephrotoxicity.

2. A 12-year-old child is receiving a blood transfusion via an infusion pump and begins to complain of 'itchy' skin 15 minutes after the unit of blood is started. The child appears flushed. What action should the nurse take first?

• A. Apply lotion to the skin
• B. Stop the transfusion
• C. Inspect the infusion site
• D. Obtain the vital signs

Correct answer: B

Rationale: Stopping the transfusion immediately is crucial when signs of a transfusion reaction, such as itching and flushing, occur. This action is taken to prevent further exposure to the potentially harmful transfused blood. Applying lotion to the skin, inspecting the infusion site, or obtaining vital signs can be important but are secondary to stopping the transfusion to ensure the safety of the child. Applying lotion may not address the underlying issue of a possible transfusion reaction. Inspecting the infusion site and obtaining vital signs can be done after stopping the transfusion, as patient safety is the top priority in this situation.

3. The nurse is assisting the recreational director of a long-term care facility in planning outdoor activities for the wheelchair-bound older residents who are mentally alert. Which activity meets the physical and social needs of these residents?

• A. An open-air concert
• B. A tea party in the courtyard
• C. A team ring-toss competition
• D. A picnic in the park

Correct answer: B

Rationale: A tea party in the courtyard provides a social and physical activity suitable for wheelchair-bound older residents who are mentally alert. It offers an opportunity for social interaction, enjoyment of the outdoors, and participation in a physical activity without the need for extensive mobility. An open-air concert may not provide the same level of social interaction or physical engagement as a tea party. A team ring-toss competition may be physically challenging for wheelchair-bound residents. A picnic in the park could present challenges related to accessibility and might not foster the same level of social interaction as a tea party in a more contained courtyard setting.

4. A client who is post-operative from a bowel resection is experiencing abdominal distention and pain. The nurse notices the client has not passed gas or had a bowel movement. What should the nurse assess first?

• A. The client's bowel sounds.
• B. The client's fluid intake.
• C. The client's pain level.
• D. The client's surgical incision.

Correct answer: A

Rationale: Assessing bowel sounds is crucial in this situation as it helps determine if the client's gastrointestinal tract is functioning properly. Absent or hypoactive bowel sounds can indicate an ileus, a common post-operative complication. Assessing fluid intake (Choice B) is important but should come after assessing bowel sounds. Pain assessment (Choice C) is essential but addressing the physiological issue should take precedence. Checking the surgical incision (Choice D) is relevant but not the priority when the client is experiencing abdominal distention and potential gastrointestinal complications.

5. A client is 48 hours post-op from a bowel resection and has not had a bowel movement. The client is complaining of abdominal pain and bloating. What is the nurse’s best action?

• A. Administer a prescribed laxative.
• B. Encourage the client to increase fluid intake.
• C. Auscultate bowel sounds.
• D. Notify the healthcare provider.

Correct answer: C

Rationale: Auscultating bowel sounds is the best initial action in this situation. It helps the nurse assess bowel function before considering interventions like administering a laxative. Abdominal pain and bloating could be indicative of bowel motility issues, and auscultation can provide crucial information. Encouraging increased fluid intake can be beneficial in promoting bowel movement, but assessing bowel sounds is more immediate to evaluate the current status. Notifying the healthcare provider should be reserved for situations where immediate intervention is needed or if the condition worsens after assessment.

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