Nursing Elites

1. How can a nurse best help a client undergoing a bone marrow aspiration and biopsy, along with two upset family members, manage anxiety during the procedure?

• A. Allow the client's family to stay for emotional support.
• B. Accompany the client silently.
• C. Encourage the client to take slow, deep breaths to promote relaxation.
• D. Provide the client an opportunity to verbalize emotions.

Correct answer: C

Rationale: Encouraging the client to take slow, deep breaths is an effective way for the nurse to help the client manage anxiety during the bone marrow aspiration and biopsy procedure. Slow, deep breathing can promote relaxation and help reduce anxiety levels. Choice A, allowing the client's family to stay for emotional support, may provide comfort but does not address a direct intervention to help manage anxiety. Choice B, staying with the client silently, may not actively help the client address their anxiety. Choice D, allowing the client to express feelings, is important but may not directly address anxiety management during the procedure.

2. A client with Diabetes Insipidus (DI) is being cared for by a nurse. Which data warrants the most immediate intervention by the nurse?

• A. Serum sodium of 185 mEq/L (185 mmol/L)
• B. Dry skin with poor skin turgor
• C. Apical rate of 110 beats per minute
• D. Polyuria and excessive thirst

Correct answer: A

Rationale: A serum sodium level of 185 mEq/L (185 mmol/L) is dangerously high and indicates severe dehydration, requiring immediate intervention to prevent neurological damage. The other options are not as critical as high serum sodium levels, which can lead to serious complications such as seizures, coma, and death if not promptly addressed. Dry skin with poor skin turgor and polyuria with excessive thirst are common findings in clients with Diabetes Insipidus and should be managed but do not pose an immediate threat to the client's life. An apical heart rate of 110 beats per minute may indicate tachycardia, which could be related to dehydration but is not as urgent as addressing the severe hypernatremia.

3. Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma?

• A. Numbness, tingling, and cramps in the extremities.
• B. Headache, diaphoresis, and palpitations.
• C. Cyanosis, fever, and classic signs of shock.
• D. Nausea, vomiting, and muscular weakness.

Correct answer: B

Rationale: Correct. Pheochromocytoma is a catecholamine-secreting non-cancerous tumor of the adrenal medulla. The classic triad of symptoms includes headache, diaphoresis (excessive sweating), and palpitations, which result from the overproduction of catecholamines like epinephrine and norepinephrine. Numbness, tingling, and cramps in the extremities (Option A) are not characteristic of pheochromocytoma. Cyanosis, fever, and classic signs of shock (Option C) are not typical symptoms of this condition. Nausea, vomiting, and muscular weakness (Option D) are not commonly associated with pheochromocytoma.

4. In a patient with chronic kidney disease, which of the following is a common complication?

• A. Hyperkalemia.
• B. Hypernatremia.
• C. Hypocalcemia.
• D. Hyperphosphatemia.

Correct answer: A

Rationale: Hyperkalemia is a common complication in chronic kidney disease due to the kidneys' reduced ability to excrete potassium. As kidney function declines, potassium levels may increase, leading to hyperkalemia. Hypernatremia (increased sodium levels), hypocalcemia (low calcium levels), and hyperphosphatemia (elevated phosphate levels) are not typically associated with chronic kidney disease. Therefore, the correct answer is hyperkalemia.

5. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient’s electrolytes with careful attention to the levels of which electrolytes?

• A. Calcium and magnesium
• B. Sodium and calcium
• C. Potassium and chloride
• D. Potassium and magnesium

Correct answer: D

Rationale: Before administering digoxin, the nurse must review the patient's electrolyte levels, focusing on potassium and magnesium. Hypomagnesemia, similar to hypokalemia, can enhance the action of digitalis and lead to digitalis toxicity. Laxatives and diuretics, like hydrochlorothiazide, can deplete both potassium and magnesium. Therefore, monitoring these electrolytes is crucial to prevent potential adverse effects associated with digoxin therapy. Choice A (Calcium and magnesium) is incorrect because calcium levels are not specifically mentioned as crucial for digoxin therapy. Choice B (Sodium and calcium) is incorrect as sodium is not typically monitored in relation to digoxin therapy. Choice C (Potassium and chloride) is incorrect because although potassium is vital, chloride is not typically associated with digoxin therapy.

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