Nursing Elites

1. The healthcare provider is caring for a client receiving total parenteral nutrition (TPN). Which laboratory value should be monitored closely to assess for complications?

• A. Serum sodium
• B. Serum calcium
• C. Blood urea nitrogen (BUN)
• D. Blood glucose

Correct answer: D

Rationale: The correct answer is D: Blood glucose. Monitoring blood glucose levels is crucial for clients receiving total parenteral nutrition (TPN) due to the high glucose content in TPN solutions. TPN delivers essential nutrients, including glucose, directly into the bloodstream. Clients on TPN are at risk of developing hyperglycemia due to the concentrated glucose infusion. Therefore, close monitoring of blood glucose levels is necessary to detect and prevent hyperglycemia-related complications such as osmotic diuresis, hyperosmolarity, and electrolyte imbalances. While serum sodium, serum calcium, and blood urea nitrogen (BUN) levels are important parameters in various clinical scenarios, they are not specifically associated with TPN administration. These values are not the primary indicators to assess for complications in clients receiving TPN.

2. A client who is post-op following a partial colectomy has an NG tube set on low continuous suction. The client complains of a sore throat and asks when the NG tube will be removed. Which response by the nurse is appropriate at this time?

• A. When the GI tract is working again, in about three to five days, the tube can be removed.
• B. The tube will be removed once your nausea improves.
• C. You can expect the tube to be removed in about a week.
• D. The tube will be removed once the drainage stops.

Correct answer: A

Rationale: The correct response is A: 'When the GI tract is working again, in about three to five days, the tube can be removed.' After a partial colectomy, the GI tract needs time to recover and start functioning properly. The NG tube is typically removed when peristalsis returns, indicating GI function restoration, which usually occurs within 3-5 days post-op. Choice B is incorrect because the removal of the NG tube is not solely based on nausea improvement. Choice C is incorrect as it provides a longer duration for tube removal than is usually necessary. Choice D is incorrect as the cessation of drainage alone does not dictate NG tube removal; the return of GI function is the primary indicator.

3. To ensure the safety of a client receiving a continuous intravenous normal saline infusion, how often should the LPN change the administration set?

• A. Every 4 to 8 hours
• B. Every 12 to 24 hours
• C. Every 24 to 48 hours
• D. Every 72 to 96 hours

Correct answer: D

Rationale: The correct answer is to change the administration set every 72 to 96 hours. This practice helps reduce the risk of infection by preventing the build-up of bacteria in the tubing. Changing the set too frequently (choices A, B, and C) may increase the chances of contamination and infection without providing additional benefits. Therefore, the LPN should follow the guideline of changing the administration set every 72 to 96 hours to maintain the client's safety during the continuous intravenous normal saline infusion.

4. A client is experiencing dehydration, and the nurse is planning care. Which of the following actions should the nurse include?

• A. Administer antihypertensives as prescribed.
• B. Check the client’s weight daily.
• C. Notify the provider if the urine output is less than 30 mL/hr.
• D. Encourage the client to ambulate independently four times a day.

Correct answer: B

Rationale: Checking the client's weight daily is essential for monitoring fluid status in dehydration. Administering antihypertensives, notifying the provider of insufficient urine output, and encouraging ambulation are not primary interventions for managing dehydration. Administering antihypertensives may affect blood pressure, but it is not a direct intervention for dehydration. Notifying the provider of a urine output less than 30 mL/hr indicates oliguria, which is a sign of reduced kidney function rather than dehydration. Encouraging ambulation is a general nursing intervention and does not directly address the fluid imbalance associated with dehydration.

5. A nurse is planning an education session for an older adult client who has just learned that she has type 2 diabetes mellitus. Which of the following strategies should the nurse plan to use with this client?

• A. Allow extra time for the client to respond to questions
• B. Expect the client to have difficulty understanding the information
• C. Avoid references to the client’s past experiences
• D. Keep the learning session private and one-on-one

Correct answer: A

Rationale: Corrected Choice A, allowing extra time for the client to respond to questions, is the appropriate strategy when educating an older adult with type 2 diabetes mellitus. Older adults may need additional time to process information and formulate responses. Choice B is incorrect as it assumes the client will have difficulty understanding the information, which may not be the case. Choice C is incorrect because referencing the client's past experiences can help personalize the education session. Choice D is also incorrect as keeping the learning session private and one-on-one may not be necessary for all clients and may limit the potential benefits of group education and support.

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