Nursing Elites

1. A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding should prompt immediate action by the nurse?

• A. Blood pressure of 76/58 mm Hg
• B. Sodium level of 138 mEq/L
• C. Potassium level of 5.5 mEq/L
• D. Pulse rate of 90 beats/min

Correct answer: A

Rationale: The correct answer is A: Blood pressure of 76/58 mm Hg. In a client undergoing continuous venovenous hemofiltration (CVVH), hypotension can be a significant concern if replacement fluid does not adequately maintain blood pressure. The nurse should take immediate action to address hypotension to prevent further complications. The sodium level of 138 mEq/L is within normal range, and a potassium level of 5.5 mEq/L, while slightly elevated, may be expected in a patient with acute kidney injury. A pulse rate of 90 beats/min falls within the normal range and does not typically require immediate intervention in this context.

2. The nurse is monitoring a client with chronic renal failure who is receiving hemodialysis. The nurse should report which of the following findings immediately?

• A. Clear dialysate outflow.
• B. Weight gain of 2 lbs (0.9 kg) since the last treatment.
• C. Blood pressure of 130/80 mm Hg.
• D. Pulse rate of 72 bpm.

Correct answer: B

Rationale: The correct answer is B. Weight gain of 2 lbs (0.9 kg) since the last treatment is concerning in a client undergoing hemodialysis with chronic renal failure as it may indicate fluid overload. This finding requires immediate reporting and intervention to prevent complications such as fluid retention, pulmonary edema, or exacerbation of heart failure. Choices A, C, and D are not findings that require immediate attention in this context. Clear dialysate outflow is a normal finding during hemodialysis, a blood pressure of 130/80 mm Hg is within a normal range for many clients, and a pulse rate of 72 bpm is also within the expected range for most individuals.

3. Which of the following lab results is most indicative of dehydration?

• A. Low sodium levels.
• B. Elevated creatinine levels.
• C. Low potassium levels.
• D. High blood glucose levels.

Correct answer: B

Rationale: Elevated creatinine levels are indicative of dehydration because when the body is dehydrated, the kidneys concentrate urine to preserve fluid, leading to higher levels of creatinine. Low sodium levels (Choice A) can be seen in conditions like hyponatremia but are not specific to dehydration. Low potassium levels (Choice C) are more commonly associated with conditions like hypokalemia. High blood glucose levels (Choice D) are typically seen in diabetes and are not specific indicators of dehydration.

4. What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?

• A. Ask the patient if she might be pregnant.
• B. Reassure the patient that this is a normal side effect.
• C. Report a possible superinfection to the provider.
• D. Suspect that the patient is having a hematologic reaction.

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.

5. The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss

• A. decreasing the dose to 50 mg QID.
• B. giving the dose 3 times daily.
• C. obtaining a serum drug level.
• D. ordering a hearing test.

Correct answer: C

Rationale: When a patient receiving gentamicin (Garamycin) reports experiencing ringing in the ears, it is crucial to consider the possibility of ototoxicity. Ototoxicity is a known adverse effect of aminoglycosides. The appropriate action for the nurse in this situation is to contact the provider to discuss obtaining a serum drug level. This is important to assess the drug concentration in the patient's blood, which can help determine if the ringing in the ears is related to the medication. Decreasing the dose or changing the dosing frequency without assessing the serum drug level may not address the underlying issue and could potentially lead to suboptimal treatment. Ordering a hearing test may be necessary at a later stage if the serum drug level indicates a concern. Therefore, option C, obtaining a serum drug level, is the most appropriate action to take in this scenario.

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