Nursing Elites

1. What is most important for the healthcare professional to do prior to initiating peritoneal dialysis?

• A. Aspirate to check placement
• B. Ensure the client voids
• C. Irrigate the catheter to maintain patency
• D. Warm the fluids

Correct answer: D

Rationale: The correct answer is to warm the fluids. Warming the dialysis fluids is crucial before initiating peritoneal dialysis to prevent abdominal discomfort and promote vasodilation, which helps in achieving good exchange in the peritoneum. Aspirating to check placement (Choice A) is not typically necessary before initiating peritoneal dialysis. Ensuring the client voids (Choice B) is not directly related to the procedure of peritoneal dialysis. Irrigating the catheter to maintain patency (Choice C) is usually done as part of routine care but is not specifically required prior to initiating peritoneal dialysis. Therefore, the most important action to take before starting peritoneal dialysis is to warm the fluids.

2. A healthcare professional is assessing a patient in the rehab unit during shift change. The patient has sustained a TBI 3 weeks ago. Which of the following is the most distinguishing characteristic of a neurological disturbance?

• A. LOC (level of consciousness)
• B. Short-term memory
• C. Babinski sign
• D. Clonus sign

Correct answer: A

Rationale: Level of consciousness (LOC) is the most crucial indicator of impaired neurological function. Changes in LOC can signify various neurological conditions, including traumatic brain injury. Short-term memory, while important, is not the most distinguishing characteristic of neurological disturbances. Babinski and Clonus signs are specific neurological tests that can provide information about upper motor neuron lesions but are not as generalizable as changes in LOC for assessing overall neurological status.

3. The nurse is caring for a client and wants to assess the neurologic function. Which of the following will give the most information?

• A. Level of consciousness
• B. Doll's eye reflex
• C. Babinski reflex
• D. Reaction to painful stimuli

Correct answer: A

Rationale: The correct answer is 'Level of consciousness.' Assessing the client's level of consciousness provides crucial information about their neurologic function, including subtle changes in verbal ability, orientation, and responsiveness to commands. Doll's eye reflex is a specific eye movement test used in neurologic assessments but may not provide as much comprehensive information as the client's overall consciousness level. The Babinski reflex is a test used to assess specific spinal cord function rather than overall neurologic function. Reaction to painful stimuli provides information about sensory function and pain response but may not offer as much insight into the client's neurologic status as assessing their level of consciousness.

4. The schizophrenic client who is admitted to the hospital for possible bowel obstruction has an NG tube and complains of pain. What should the nurse do at this time?

• A. Decrease the stimuli and observe frequently
• B. Administer the PRN sedative
• C. Call the physician immediately
• D. Administer the PRN pain medication

Correct answer: D

Rationale: In this scenario, the nurse should administer the PRN (as needed) pain medication to address the schizophrenic client's complaint of pain. It is essential to provide relief and comfort to the client experiencing pain. Option A, decreasing stimuli and observing frequently, may not address the underlying cause of pain and delay relief. Option B, administering a sedative, does not target the pain but may mask symptoms. Option C, calling the physician immediately, while important in some situations, is not the most immediate action needed to alleviate the client's pain. Therefore, the most appropriate action at this time is to administer the PRN pain medication to help alleviate the client's discomfort.

5. A nurse at an outpatient clinic is returning phone calls that have been made to the clinic. Which of the following calls should have the highest priority for medical intervention?

• A. A home health patient reports, "I am starting to have a breakdown of my heels."?
• B. A patient that received an upper extremity cast yesterday reports, "I can't feel my fingers in my right hand today."?
• C. A young female reports, 'I think I sprained my ankle about 2 weeks ago.'
• D. A middle-aged patient reports, 'My knee is still hurting from the TKR.'

Correct answer: B

Rationale: The correct answer is the patient who received an upper extremity cast yesterday and reports not being able to feel their fingers in the right hand. This situation indicates a potential neurovascular issue that requires immediate attention to prevent complications. The other options are of lesser priority: A - Breakdown of the heels, while concerning, is not an acute issue that necessitates immediate intervention. C - An ankle sprain that occurred two weeks ago is now subacute and unlikely to be an urgent medical concern. D - Pain in the knee following a total knee replacement (TKR) is common in the early postoperative period and is not unexpected.

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