Nursing Elites

1. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

2. The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:

• A. Perform the procedure safely and correctly.
• B. Critique the nurse's performance of the procedure.
• C. Explain all steps of the procedure correctly.
• D. Correctly answer a post-test about the procedure.

Correct answer: A

Rationale: The best indicator of learning is the ability to perform the procedure safely and correctly, demonstrating skill acquisition. Choice A is correct because the client's ability to perform the insulin self-injection safely and correctly shows practical understanding and application of the skill. Choice B is incorrect because critiquing the nurse's performance does not necessarily demonstrate the client's ability to carry out the procedure themselves. Choice C is incorrect as merely explaining the steps verbally does not confirm the client's practical execution of the task. Choice D is also incorrect as answering a post-test does not directly assess the client's ability to physically perform the insulin self-injection.

3. A client who has just undergone bronchoscopy was returned to the nursing unit 1 hour ago. With which assessment finding is the nurse most concerned?

• A. Oxygen saturation of 97%
• B. Equal breath sounds in both lungs
• C. Absence of cough and gag reflexes
• D. Respiratory rate of 20 breaths/min

Correct answer: C

Rationale: The correct answer is C. The absence of cough and gag reflexes is the most concerning finding for the nurse because it indicates a lack of protective airway reflexes, putting the client at risk of aspiration. Oxygen saturation of 97% is within the normal range and indicates adequate oxygenation. Equal breath sounds in both lungs are a positive finding, indicating no significant abnormalities. A respiratory rate of 20 breaths/min is also within the normal range and does not raise immediate concerns. Therefore, the absence of cough and gag reflexes poses the highest risk to the client's airway safety.

4. A female client taking oral contraceptives reports to the nurse that she is experiencing calf pain. What action should the nurse implement?

• A. Determine if the client has also experienced breast tenderness and weight gain.
• B. Encourage the client to begin a regular, daily program of walking and exercise.
• C. Advise the client to notify the healthcare provider for immediate medical attention.
• D. Tell the client to stop taking the medication for a week to see if symptoms subside.

Correct answer: C

Rationale: Calf pain is indicative of thrombophlebitis, a serious, life-threatening complication associated with the use of oral contraceptives which requires further assessment and possibly immediate medical intervention.

5. What do crackles heard on lung auscultation indicate?

• A. Cyanosis.
• B. Bronchospasm.
• C. Airway narrowing.
• D. Fluid-filled alveoli.

Correct answer: D

Rationale: Crackles heard on lung auscultation are caused by the popping open of small airways that are filled with fluid. This is commonly associated with conditions such as pulmonary edema, pneumonia, or heart failure. Cyanosis (Choice A) is a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood, not directly related to crackles. Bronchospasm (Choice B) refers to the constriction of the airway smooth muscle, causing difficulty in breathing but does not typically produce crackles. Airway narrowing (Choice C) can lead to wheezing but is not directly linked to crackles heard on auscultation.

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