Nursing Elites

1. The nurse is administering total parenteral nutrition (TPN) via a central line at 75 ml/hour to a client who had a bowel resection 4 days ago. Which laboratory finding requires the most immediate intervention by the nurse?

• A. Blood glucose of 140 mg/dL
• B. White blood cell count of 8000/mm³
• C. Serum potassium of 3.8 mEq/L
• D. Serum calcium of 7.8 mg/dL

Correct answer: D

Rationale: The correct answer is D. A serum calcium level of 7.8 mg/dL requires immediate intervention due to the risk of hypocalcemia. Hypocalcemia can lead to serious complications such as tetany, seizures, and cardiac arrhythmias. The other laboratory findings are within normal limits or slightly elevated, which do not pose an immediate threat to the client's health in this scenario.

2. When administering an intramuscular injection containing 3 ml of a painful medication, which intervention should the nurse implement?

• A. Instill the medication quickly
• B. Insert the needle slowly
• C. Select a large, deep muscle mass
• D. Use a short, small gauge needle

Correct answer: C

Rationale: The correct answer is C: Select a large, deep muscle mass. When administering an intramuscular injection with a painful medication volume of 3 ml, selecting a large and deep muscle mass is crucial. This intervention reduces discomfort for the patient and ensures proper absorption of the medication. Choice A is incorrect because instilling the medication quickly can increase discomfort. Choice B is incorrect as inserting the needle slowly may prolong the discomfort. Choice D is incorrect as using a short, small gauge needle may not be suitable for delivering 3 ml of medication effectively into the muscle.

3. A client with a history of seizures is being discharged with a prescription for phenytoin (Dilantin). Which instruction should the nurse provide this client?

• A. Take the medication with meals
• B. Avoid alcohol while taking this medication
• C. Limit sodium intake
• D. Take the medication at bedtime

Correct answer: B

Rationale: The correct instruction is to advise the client to avoid alcohol while taking phenytoin. Alcohol can interact with phenytoin, making it less effective and leading to increased side effects. Taking the medication with meals (Choice A) may help reduce gastrointestinal upset but is not the most crucial instruction for this medication. Limiting sodium intake (Choice C) is not directly related to phenytoin therapy. Taking the medication at bedtime (Choice D) is not a standard instruction for phenytoin administration.

4. A healthcare provider is assessing a client who is receiving treatment for dehydration. Which assessment finding indicates that the client is responding to the treatment?

• A. Dry mucous membranes
• B. Increased urine output
• C. Decreased skin turgor
• D. Elevated heart rate

Correct answer: B

Rationale: Increased urine output is a positive sign indicating that the client is responding to the treatment for dehydration. It suggests that the client's kidneys are functioning better, helping to eliminate excess fluid and waste products from the body. Dry mucous membranes (Choice A) are a sign of dehydration, not improvement. Decreased skin turgor (Choice C) and elevated heart rate (Choice D) are also symptoms of dehydration and do not indicate a positive response to treatment.

5. A 2-year-old boy with short bowel syndrome has progressed to receiving enteral feedings only. Today his stools are occurring more frequently and have a more liquid consistency. His temperature is 102.2°F and he has vomited twice in the past four hours. Which assessment finding indicates that the child is becoming dehydrated?

• A. Occult blood in the stool
• B. Abdominal distention
• C. Elevated urine specific gravity
• D. Hyperactive bowel sounds

Correct answer: C

Rationale: Elevated urine specific gravity is a sign of dehydration in children. In the scenario provided, the child is experiencing increased stool frequency, liquid consistency, fever, and vomiting, indicating fluid loss and potential dehydration. Occult blood in the stool may suggest gastrointestinal bleeding but is not a direct indicator of dehydration. Abdominal distention can be seen in various conditions and is not specific to dehydration. Hyperactive bowel sounds are more commonly associated with increased bowel motility, not necessarily dehydration.

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