Nursing Elites

1. Place a washcloth between the skin and tourniquet

• A. Provide a bed bath instead of letting the client take a shower
• B. Use sterile technique when changing the dressing.
• C. Disconnect the intravenous fluid tubing prior to the clients bath.
• D. Use a plastic bag to cover the extremity with the device

Correct answer: D

Rationale:

2. A home care nurse prepares to administer intravenous medication to a client. The nurse assesses the site and reviews the clients chart prior to administering the medication: Client: Thomas Jackson DOB: 5/3/1936 Gender: Male January 23 (Today): Right uppe

• A. Notify the health care provider
• B. . Administer the prescribed medication.
• C. Discontinue the PICC
• D. Switch the medication to the oral route

Correct answer: B

Rationale:

3. 1.A nurse prepares to insert a peripheral venous catheter in an older adult client. Which action should the nurse take to protect the clients skin during this procedure?

• A. Lower the extremity below the level of the heart.
• B. Apply warm compresses to the extremity.
• C. Tap the skin lightly and avoid slapping.
• D. Place a washcloth between the skin and tourniquet

Correct answer: D

Rationale:

4. You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?

• A. Hypertension
• B. Kussmaul respirations
• C. Increased DTRs
• D. Shallow respirations

Correct answer: D

Rationale:

5. A patient is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is 6 mEq/L. For this patient, the nurse's priority would be to assess her:

• A. Neuromuscular function
• B. Bowel sounds
• C. Respiratory rate
• D. Electrocardiogram (ECG) results

Correct answer: D

Rationale: In a patient with a serum potassium level of 6 mEq/L due to spironolactone use, the nurse's priority is to assess the Electrocardiogram (ECG) results. Hyperkalemia can lead to life-threatening arrhythmias, such as ventricular fibrillation, which can be detected on an ECG. While changes in neuromuscular function, bowel sounds, and respiratory rate can occur with hyperkalemia, the most critical assessment related to the patient's condition would be monitoring the ECG for signs of cardiac complications.

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