Nursing Elites

1. Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the circulating nurse if a 3-minute surgical hand scrub is adequate preparation for this client. Which response should the circulating nurse provide?

• A. Ask a more experienced nurse to perform that scrub since it is the first time of the day
• B. Validate the nurse is implementing the OR policy for surgical hand scrub
• C. Inform the nurse that hand scrubs should be 3 minutes between cases.
• D. Direct the nurse to continue the surgical hand scrub for a 5-minute duration.

Correct answer: D

Rationale: The correct answer is to direct the nurse to continue the surgical hand scrub for a 5-minute duration. Surgical hand scrubs should last for 5 to 10 minutes, ensuring thorough cleaning and disinfection. Choice A is incorrect because the nurse should be guided to complete the scrub properly rather than having someone else do it. Choice B is incorrect as it does not address the duration of the hand scrub. Choice C is incorrect as it suggests a 3-minute hand scrub is sufficient, which is inadequate for proper preparation before surgery.

2. An adult female client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The nurse notices the client has more energy and is giving her belongings away. Which intervention is best for the nurse to implement?

• A. Support the client by praising her progress.
• B. Ask the client if she has had any recent thoughts of harming herself.
• C. Reassure the client about the effectiveness of antidepressant drugs.
• D. Advise the client to keep her belongings for discharge.

Correct answer: B

Rationale: The correct intervention is to ask the client if she has had any recent thoughts of harming herself because increased energy and giving away belongings can be signs of suicidal ideation. Choice A is incorrect as it does not address the potential risk of self-harm. Choice C is incorrect because reassurance about medication effectiveness may not be appropriate in this situation. Choice D is incorrect as it dismisses the client's current behavior without addressing the underlying concern of potential self-harm.

3. A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?

• A. Serum creatinine of 1.8 mg/dl
• B. Prothrombin time of 18 seconds
• C. Hemoglobin of 9 g/dl
• D. Platelet count of 90,000/mm3

Correct answer: D

Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.

4. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which laboratory value should be reported to the healthcare provider before the procedure?

• A. Serum creatinine of 2.5 mg/dL
• B. Serum potassium of 6.5 mEq/L
• C. Serum calcium of 8 mg/dL
• D. Serum bicarbonate of 24 mEq/L

Correct answer: B

Rationale: The correct answer is B. A serum potassium level of 6.5 mEq/L is dangerously high and should be reported before hemodialysis to prevent cardiac complications. High potassium levels can lead to life-threatening arrhythmias. Serum creatinine (Choice A) is elevated in renal dysfunction but not the most critical value to report before hemodialysis. Serum calcium (Choice C) and serum bicarbonate (Choice D) levels are within normal limits and are not immediate concerns before hemodialysis.

5. The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value should be closely monitored?

• A. Serum potassium level
• B. Hemoglobin level
• C. White blood cell count
• D. Serum sodium level of 135 mEq/L

Correct answer: A

Rationale: The correct answer is A: Serum potassium level. In clients receiving erythropoietin therapy for chronic kidney disease, monitoring serum potassium levels is crucial due to the risk of developing hyperkalemia. Erythropoietin therapy can stimulate red blood cell production, leading to an increase in potassium levels. Monitoring potassium levels helps prevent complications associated with hyperkalemia, such as cardiac arrhythmias. Choices B, C, and D are incorrect because while hemoglobin levels are relevant for assessing the effectiveness of erythropoietin therapy, monitoring potassium levels is more critical due to the potential adverse effects of elevated potassium levels in CKD patients on this therapy.

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