Nursing Elites

1. A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: D

Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.

2. A client is undergoing hemodialysis. The client’s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

• A. Adjust the rate of extracorporeal blood flow.
• B. Place the client in the Trendelenburg position.
• C. Administer a 250-mL bolus of normal saline.
• D. All of the above

Correct answer: D

Rationale: During hemodialysis, a drop in blood pressure can occur due to fluid removal. To maintain blood pressure, the nurse should consider adjusting the rate of extracorporeal blood flow to optimize fluid removal without causing hypotension. Placing the client in the Trendelenburg position can help improve venous return and cardiac output. Administering a bolus of normal saline can help increase intravascular volume and support blood pressure. Therefore, all the actions listed in choices A, B, and C are appropriate measures to maintain blood pressure during hemodialysis. Choice D, 'All of the above,' is the correct answer as it encompasses all the relevant actions to address the dropping blood pressure effectively. Choices A, B, and C, when implemented together, can help manage hypotension during hemodialysis.

3. A client with acute kidney injury (AKI) weighing 50kg and having a potassium level of 6.7mEq/L (6.7mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first?

• A. Calcium acetate, one tablet by mouth
• B. Sodium polystyrene sulfonate, 15 grams by mouth
• C. Epoetin Alfa, recombinant, 2,500 units subcutaneously
• D. Sevelamer, one tablet by mouth

Correct answer: B

Rationale: In a client with acute kidney injury (AKI) and hyperkalemia, the priority intervention is to lower the potassium level swiftly. Sodium polystyrene sulfonate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, reducing the overall potassium levels. Calcium acetate, epoetin alfa, and sevelamer are not indicated for the immediate reduction of potassium levels in hyperkalemia. Calcium acetate is used to control phosphate levels, epoetin alfa is a medication to treat anemia by stimulating red blood cell production, and sevelamer is a phosphate binder used in chronic kidney disease to reduce phosphate levels.

4. Which of the following medications is commonly prescribed for hypertension?

• A. Atenolol
• B. Aspirin
• C. Ibuprofen
• D. Metformin

Correct answer: A

Rationale: The correct answer is Atenolol. Atenolol is a beta-blocker commonly prescribed to manage hypertension due to its ability to reduce the heart rate and lower blood pressure. Options B, C, and D are incorrect because aspirin, ibuprofen, and metformin are not typically used as first-line treatments for hypertension. Aspirin is more commonly used for its antiplatelet effects, ibuprofen is a nonsteroidal anti-inflammatory drug, and metformin is primarily used for managing diabetes.

5. What is the correct procedure for performing an ophthalmoscopic examination on a client's right retina?

• A. Instruct the client to focus on a distant object behind the examiner and not move their eyes during the exam.
• B. Set the ophthalmoscope on the plus 2 to 3 lens and hold it in front of the examiner's right eye.
• C. From a distance of 12 to 15 inches and slightly to the side, shine the light into the client's pupil.
• D. For optimal visualization, keep the ophthalmoscope at least 3 inches from the client's eye.

Correct answer: C

Rationale: During an ophthalmoscopic examination, the client should focus on a distant object behind the examiner to dilate the pupil, and the examiner should stand at a distance of 12-15 inches away and slightly to the side. This angle allows for better visualization of the retina. Holding the ophthalmoscope firmly against the examiner's face and shining the light into the client's pupil helps examine the retina effectively. Choice A is incorrect because the client should look at a distant object, not the examiner's nose. Choice B is incorrect as the ophthalmoscope should be directed towards the client's eye, not the examiner's eye. Choice D is incorrect because keeping the ophthalmoscope at least 3 inches away may not provide an optimal view of the retina.

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