Nursing Elites

1. The nurse is caring for a client who is receiving an IV infusion of normal saline and notices that the infusion is not flowing. The insertion site is not inflamed or swollen. What should the nurse do first?

• A. Check the tubing for kinks or obstructions.
• B. Increase the flow rate to improve the infusion.
• C. Reinsert the IV catheter in another vein.
• D. Call the physician for further instructions.

Correct answer: A

Rationale: The correct first action for the nurse to take when an IV infusion is not flowing despite a normal insertion site is to check the tubing for kinks or obstructions. This step is crucial to ensure that there are no preventable issues impeding the flow of the IV solution. Increasing the flow rate without addressing potential obstructions could lead to complications such as infiltration. Reinserting the IV catheter in another vein should only be considered after ruling out tubing issues. Calling the physician for further instructions is not necessary at this stage as troubleshooting the tubing should be the initial intervention.

2. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?

• A. Discuss what the treatment regimen means to him.
• B. Refer the client to a mental health nurse practitioner.
• C. Reschedule the appointments to another date and time.
• D. Discuss the option of peritoneal dialysis.

Correct answer: A

Rationale: The best initial action for the nurse in this scenario is to have a discussion with the client about what the treatment regimen means to him. It is important to assess the client's anxiety, coping styles, and acceptance of the required treatment for CKD. The client may be in denial of the diagnosis or may have concerns that need to be addressed. While rescheduling hemodialysis appointments could be helpful, referring the client to a mental health nurse practitioner or discussing peritoneal dialysis are not the most appropriate first steps. Understanding the client's perspective and concerns is crucial before exploring other interventions.

3. A patient is taking a thiazide diuretic and reports anorexia and fatigue. The nurse suspects which electrolyte imbalance in this patient?

• A. Hypercalcemia
• B. Hypocalcemia
• C. Hyperkalemia
• D. Hypokalemia

Correct answer: D

Rationale: The correct answer is D: Hypokalemia. Thiazide diuretics lead to potassium loss, potentially causing hypokalemia. Anorexia and fatigue are common manifestations of hypokalemia. Hypercalcemia (choice A) and hypocalcemia (choice B) are not directly associated with thiazide diuretics. Hyperkalemia (choice C) is less likely than hypokalemia to be caused by thiazide diuretics.

4. In a patient with cirrhosis, which of the following lab results is most concerning?

• A. Elevated liver enzymes.
• B. Low albumin levels.
• C. Elevated bilirubin levels.
• D. Low platelet count.

Correct answer: D

Rationale: In a patient with cirrhosis, a low platelet count is the most concerning lab result. Thrombocytopenia, or low platelet count, is common in cirrhosis due to impaired platelet production in the liver. It significantly increases the risk of bleeding and can lead to serious complications such as hemorrhage. Elevated liver enzymes (Choice A) are expected in cirrhosis but may not directly indicate the severity of the disease. Low albumin levels (Choice B) are common in cirrhosis and can contribute to fluid retention but do not pose an immediate risk of bleeding. Elevated bilirubin levels (Choice C) are also expected in cirrhosis and typically indicate impaired liver function but do not directly increase the risk of bleeding as much as a low platelet count.

5. A client is receiving intermittent bolus feedings via a nasogastric tube. In which position should the nurse place the client once the feeding is complete?

• A. Supine
• B. Head of bed flat
• C. Left lateral position
• D. Head of bed elevated 30 to 45 degrees

Correct answer: B

Rationale: After intermittent bolus feedings through a nasogastric tube, the correct position for the client is to keep the head of the bed flat. This position helps prevent vomiting and aspiration. Placing the client in a supine position (choice A) can increase the risk of aspiration. The left lateral position (choice C) is not typically used after nasogastric tube feedings. Elevating the head of the bed 30 to 45 degrees (choice D) is suitable for continuous tube feedings to reduce the risk of aspiration, but for intermittent bolus feedings, keeping the head of the bed flat is preferred to prevent regurgitation and aspiration.

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