Nursing Elites

1. What is the best way to monitor fluid balance in a patient receiving diuretics?

• A. Monitor daily weight
• B. Monitor intake and output
• C. Monitor blood pressure
• D. Check for edema

Correct answer: A

Rationale: Corrected Rationale: Daily weight monitoring is the most accurate way to assess fluid balance in patients receiving diuretics. Monitoring daily weight allows healthcare providers to track changes in fluid status more precisely. While monitoring intake and output (choice B) is essential, it may not provide a comprehensive picture of overall fluid balance. Monitoring blood pressure (choice C) is important but may not directly reflect fluid balance. Checking for edema (choice D) is useful but may not be as sensitive as daily weight monitoring in assessing fluid balance.

2. A healthcare professional is preparing to administer digoxin to a client with heart failure. Which of the following laboratory values should the professional report to the provider?

• A. Potassium 4.0 mEq/L
• B. Calcium 9.5 mg/dL
• C. Sodium 140 mEq/L
• D. Magnesium 2.0 mg/dL

Correct answer: C

Rationale: The correct answer is C: Sodium 140 mEq/L. An elevated sodium level can affect the effectiveness of digoxin therapy and may lead to toxicity. Therefore, it is crucial to report this value to the provider. Potassium, calcium, and magnesium levels are important as well, but elevated sodium can have a more direct impact on digoxin therapy in this scenario.

3. A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following findings should the nurse report to the provider?

• A. Potassium 4.0 mEq/L
• B. Calcium 9.5 mg/dL
• C. Heart rate of 60/min
• D. Sodium 140 mEq/L

Correct answer: C

Rationale: The correct answer is C: Heart rate of 60/min. A heart rate of 60/min is borderline bradycardia, which can be a sign of digoxin toxicity. Digoxin can cause bradycardia, so any further decrease in heart rate should be reported promptly to the healthcare provider. Choices A, B, and D are within the normal range and not specifically related to potential digoxin toxicity, so they do not require immediate reporting.

4. A nurse is preparing to reposition a client who had a stroke. Which of the following actions should the nurse take?

• A. Raise the side rails on both sides of the client's bed during repositioning.
• B. Reposition the client without assistive devices.
• C. Discuss the client's preferences to determine a repositioning schedule.
• D. Evaluate the client's ability to help with repositioning.

Correct answer: D

Rationale: The correct answer is to evaluate the client's ability to help with repositioning. When caring for a client who had a stroke, assessing their ability to participate in repositioning is crucial for promoting safety and encouraging their involvement in their care. This evaluation helps determine the level of assistance needed and supports the client's autonomy. Option A is incorrect because raising the side rails alone does not address the client's active involvement in repositioning. Option B is incorrect as using assistive devices may be necessary for safe repositioning. Option C is incorrect as discussing preferences is important but does not directly address the client's ability to assist in repositioning.

5. A client with bipolar disorder and experiencing mania is under the care of a nurse. Which intervention should the nurse include in the plan?

• A. Encourage the client to spend time in the day room.
• B. Withdraw the client's TV privileges if they do not attend group therapy.
• C. Encourage the client to take frequent rest periods.
• D. Place the client in seclusion when they exhibit signs of anxiety.

Correct answer: C

Rationale: Encouraging the client to take frequent rest periods is the appropriate intervention when caring for a client with bipolar disorder experiencing mania. During manic episodes, individuals often exhibit hyperactivity and may become exhausted. Rest periods can help reduce these symptoms. Choices A, B, and D are incorrect. Spending time in the day room may not address the client's need for rest, withdrawing TV privileges is not directly related to managing mania symptoms, and placing the client in seclusion when anxious can escalate the situation rather than promoting a calming environment.

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