Nursing Elites

1. The nurse is caring for a client with fluid overload. The most reliable indicator of fluid volume status is

• A. Body weight
• B. Intake and output
• C. Daily weight
• D. Skin turgor

Correct answer: C

Rationale: Daily weight is the most reliable indicator of fluid volume status as it reflects changes in body fluid balance accurately. Body weight alone can fluctuate due to various factors, including food intake and bowel movements, which may not accurately represent fluid status. Intake and output provide information on fluid balance over time but may not reflect immediate changes. Skin turgor is a physical assessment finding that indicates hydration status, not overall fluid volume status.

2. A client with cervical cancer is hospitalized for insertion of a sealed internal cervical radiation implant. What action should the nurse take when finding the radiation implant in the bed?

• A. Call radiation therapy for assistance
• B. Place the implant in a lead container using long-handled forceps
• C. Leave the implant in the bed and notify the provider
• D. Dispose of the implant in the nearest sharps container

Correct answer: B

Rationale: The correct action for the nurse to take when finding the radiation implant in the bed is to use long-handled forceps to place the implant in a lead container. This procedure is crucial in reducing radiation exposure to both the patient and healthcare providers. Calling radiation therapy for assistance (Choice A) may delay the immediate need for safe handling of the implant. Leaving the implant in the bed and notifying the provider (Choice C) is unsafe and can lead to increased radiation exposure. Disposing of the implant in a sharps container (Choice D) is incorrect as the implant should be placed in a lead container, not a sharps container, to contain the radiation.

3. A client is admitted to isolation with active tuberculosis. What infection control measures should the nurse implement?

• A. Initiate protective environment precautions.
• B. Use droplet precautions only.
• C. Ensure a positive pressure environment in the room.
• D. Implement negative pressure and contact precautions.

Correct answer: D

Rationale: When caring for a client with active tuberculosis, it is crucial to implement negative pressure rooms and contact precautions to prevent the spread of infection. Choice A, initiating protective environment precautions, is incorrect as this is not the recommended approach for tuberculosis. Choice B, using droplet precautions only, is insufficient as tuberculosis requires additional precautions. Choice C, ensuring a positive pressure environment in the room, is incorrect because negative pressure rooms are necessary to contain airborne pathogens like tuberculosis. Therefore, the most appropriate measures include implementing negative pressure rooms and contact precautions.

4. An older client is admitted with fluid volume deficit and dehydration. Which assessment finding is the best indicator of hydration status?

• A. Urine specific gravity of 1.040.
• B. Systolic blood pressure decreases by 10 points when standing.
• C. The client denies feeling thirsty.
• D. Skin turgor exhibits tenting on the forearm.

Correct answer: A

Rationale: In the context of fluid volume deficit and dehydration, urine specific gravity of 1.040 is the best indicator of hydration status. High urine specific gravity indicates concentrated urine, suggesting dehydration. Choice B, systolic blood pressure decreasing when standing, is more indicative of orthostatic hypotension rather than hydration status. Choice C, denial of thirst, is a subjective finding and may not always reflect actual hydration status. Choice D, skin turgor exhibiting tenting on the forearm, is a sign of dehydration but may not be as accurate as urine specific gravity in assessing hydration status.

5. Where should the healthcare provider consider starting a screening program for hypothyroidism?

• A. A business and professional women’s group.
• B. An African-American senior citizens' center.
• C. A daycare center in a Hispanic neighborhood.
• D. An after-school center for Native American teens.

Correct answer: B

Rationale: An African-American senior citizens' center is the most appropriate location to start a screening program for hypothyroidism. Older adults are at an increased risk of hypothyroidism, and African-Americans are more likely to be underserved in healthcare. Therefore, targeting this group can help in early detection and management of hypothyroidism. The other options, such as a business and professional women’s group, a daycare center in a Hispanic neighborhood, and an after-school center for Native American teens, do not align as closely with the demographic at higher risk for hypothyroidism.

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