Nursing Elites

1. The PN identifies an electrolyte imbalance, exhibited by changes in mental status, and an elevated blood pressure for a client with progressive heart disease. Which intervention should the PN implement first?

• A. Record usual eating patterns
• B. Evaluate for muscle cramping
• C. Document abdominal girth
• D. Elevate both legs on pillows

Correct answer: B

Rationale: Evaluating for muscle cramping, which is a sign of electrolyte imbalance, is crucial in this scenario. Electrolyte imbalances, especially involving potassium or calcium, can lead to serious complications such as arrhythmias or seizures, which need immediate attention. Recording eating patterns (choice A) may be important for overall assessment but is not the priority in this situation. Documenting abdominal girth (choice C) and elevating legs on pillows (choice D) are not directly related to addressing the immediate concern of electrolyte imbalance and its potential complications.

2. After a hip replacement surgery, a client is instructed to use an abduction pillow while in bed. What is the primary purpose of this device?

• A. To reduce the risk of blood clots.
• B. To prevent hip dislocation.
• C. To improve circulation in the legs.
• D. To alleviate pain and discomfort.

Correct answer: B

Rationale: The primary purpose of using an abduction pillow after hip replacement surgery is to prevent hip dislocation. The abduction pillow keeps the legs separated, which reduces the risk of hip dislocation by preventing excessive internal rotation and adduction of the hip joint. Choices A, C, and D are incorrect as the main goal of using the abduction pillow is to maintain proper positioning and stability of the hip joint to prevent dislocation, rather than addressing blood clots, circulation, or pain relief.

3. During a routine prenatal visit at the antepartal clinic, a multipara at 35-weeks gestation presents with 2+ edema of the ankles and feet. Which additional information should the PN report to the RN?

• A. Due date
• B. Blood pressure
• C. Gravida and parity
• D. Fundal height

Correct answer: B

Rationale: Blood pressure is the most critical information to report to the RN in this scenario. The presence of edema, along with high blood pressure, can be indicative of preeclampsia, a severe condition in pregnancy. Monitoring blood pressure is essential for assessing the patient's condition and taking appropriate actions if necessary. Choices A, C, and D are not as urgent in this situation. The due date, gravida, and parity are important for overall assessment but do not address the immediate concern of potential preeclampsia. Fundal height is used to assess fetal growth and position but is not the priority when edema and high blood pressure are present.

4. What is the most effective method to prevent medication errors during administration?

• A. Relying on memory for medication dosages
• B. Using a bar-code medication administration system
• C. Administering medications as quickly as possible to avoid delays
• D. Allowing another individual to administer medications

Correct answer: B

Rationale: Using a bar-code medication administration system is the best method to prevent medication errors during administration. This system verifies medication details electronically, ensuring that the correct medication is given to the right patient. Relying on memory for medication dosages (choice A) is not recommended as it can lead to errors. Administering medications quickly (choice C) may increase the risk of mistakes due to haste. Allowing another individual (choice D) to administer medications does not address the root cause of preventing errors during administration.

5. The PN administered darbepoetin alfa to a client with chronic kidney disease (CKD). Which serum laboratory value should the PN monitor to assess the effectiveness of this drug?

• A. Calcium
• B. Phosphorus
• C. Hemoglobin
• D. White blood cell count

Correct answer: C

Rationale: Darbepoetin alfa is used to stimulate red blood cell production in clients with CKD. Monitoring hemoglobin levels is essential to assess the effectiveness of the treatment and to adjust the dosage to avoid complications such as hypertension or thrombosis. Monitoring calcium (Choice A), phosphorus (Choice B), or white blood cell count (Choice D) is not directly related to the effectiveness of darbepoetin alfa in treating anemia associated with CKD.

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