Nursing Elites

1. What is the appropriate nursing intervention for a patient with suspected deep vein thrombosis (DVT)?

• A. Administer anticoagulants
• B. Encourage ambulation
• C. Apply compression stockings
• D. Monitor oxygen saturation

Correct answer: A

Rationale: The correct answer is to administer anticoagulants. Anticoagulants help prevent further clot formation in patients with suspected DVT. Encouraging ambulation can be beneficial in preventing DVT but is not the immediate intervention for a suspected case. Compression stockings are more for DVT prevention rather than treatment. Monitoring oxygen saturation is important in assessing respiratory function but is not the primary intervention for suspected DVT.

2. What is the best dietary recommendation for a patient with chronic kidney disease?

• A. Low-protein diet
• B. High-protein diet
• C. Low-sodium diet
• D. High-sodium diet

Correct answer: C

Rationale: The correct answer is a low-sodium diet. Patients with chronic kidney disease are often advised to follow a low-sodium diet to help manage fluid retention. Excessive sodium intake can lead to fluid buildup in the body, causing complications for individuals with kidney issues. Choices A and B are incorrect because while protein intake may need to be monitored in kidney disease, the primary focus is typically on sodium restriction. Choice D is incorrect as a high-sodium diet would exacerbate fluid retention in patients with chronic kidney disease.

3. A nurse is caring for a client who is receiving enteral feedings through a nasogastric tube. Which of the following findings should the nurse report to the provider?

• A. Gastric residual of 200 mL or more
• B. pH of gastric contents is 5.0
• C. Bowel sounds are present in all quadrants
• D. Temperature 37.5°C (99.5°F)

Correct answer: A

Rationale: The correct answer is A. A gastric residual of 200 mL or more indicates delayed gastric emptying, which can be a sign of potential complications such as aspiration or intolerance to the enteral feedings. This finding should be reported to the healthcare provider for further evaluation and possible intervention. Choices B, C, and D are within normal limits and do not require immediate reporting. A pH of 5.0 is normal for gastric contents, bowel sounds in all quadrants indicate normal gastrointestinal motility, and a temperature of 37.5°C (99.5°F) is within the normal range.

4. What is the priority nursing intervention for a patient with hyperkalemia?

• A. Administer calcium gluconate
• B. Administer insulin
• C. Administer sodium bicarbonate
• D. Administer a diuretic

Correct answer: A

Rationale: The correct answer is to administer calcium gluconate. In hyperkalemia, the priority is to protect the heart from potential complications like arrhythmias. Calcium gluconate is the first-line treatment as it stabilizes the cardiac cell membrane. Insulin (Choice B) and sodium bicarbonate (Choice C) can be used in conjunction with other treatments to shift potassium into cells, but calcium gluconate is the priority. Administering a diuretic (Choice D) is not the primary intervention for hyperkalemia and can even worsen the condition by reducing potassium excretion.

5. A healthcare professional is caring for a client who has a prescription for enoxaparin. Which of the following laboratory tests should the healthcare professional review before administering the medication?

• A. Prothrombin time (PT)
• B. INR
• C. Platelet count
• D. Potassium levels

Correct answer: D

Rationale: Corrected Rationale: Before administering enoxaparin, it is essential to review potassium levels to monitor for potential imbalances. Enoxaparin, a type of anticoagulant, does not directly affect PT, INR, or platelet count. Monitoring potassium levels is crucial to ensure the safety and effectiveness of the medication. PT and INR are typically used to monitor warfarin therapy, while platelet count is essential for assessing clotting function but is not directly related to enoxaparin administration.

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