Nursing Elites

1. A client with a history of chronic kidney disease (CKD) is scheduled for a CT scan with contrast. Which laboratory value should the nurse review before the procedure?

• A. Serum creatinine
• B. Blood urea nitrogen (BUN)
• C. Serum potassium
• D. Serum glucose

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Before a CT scan with contrast, the nurse should review the serum creatinine level. This is crucial in patients with CKD because contrast agents can potentially worsen kidney function and lead to contrast-induced nephropathy. Monitoring serum creatinine helps assess kidney function and determine the risk of complications. Choices B, C, and D are less relevant in this scenario. Blood urea nitrogen (BUN) is another marker of kidney function, but serum creatinine is a more specific indicator. Serum potassium levels are important in assessing electrolyte balance but are not directly related to the risk of contrast-induced nephropathy. Serum glucose levels are not typically a primary concern before a CT scan with contrast in a patient with CKD.

2. For the past 24 hours, an antidiarrheal agent, diphenoxylate, has been administered to a bedridden, older client with infectious gastroenteritis. Which finding requires the nurse to take further action?

• A. Tented skin turgor
• B. Decreased bowel sounds
• C. Persistent diarrhea
• D. Dehydration

Correct answer: A

Rationale: The correct answer is A. Tented skin turgor is a sign of dehydration, which can be exacerbated by the use of antidiarrheals in clients with gastroenteritis. In dehydration, the skin loses its elasticity and becomes less resilient when pinched. Therefore, the nurse should take immediate action upon noticing tented skin turgor to prevent further complications. Choices B, C, and D are incorrect because decreased bowel sounds, persistent diarrhea, and dehydration are expected findings in a client with gastroenteritis who has been administered an antidiarrheal agent.

3. The nurse discovers that an elderly client with no history of cardiac or renal disease has an elevated serum magnesium level. To further investigate the cause of this electrolyte imbalance, what information is most important for the nurse to obtain from the client's medical history?

• A. Frequency of laxative use for chronic constipation
• B. Dietary intake of magnesium-rich foods
• C. Use of magnesium-containing supplements
• D. History of alcohol use

Correct answer: A

Rationale: The correct answer is A. Frequent use of magnesium-containing laxatives can lead to hypermagnesemia, particularly in elderly clients. Option B, dietary intake of magnesium-rich foods, may contribute to elevated serum magnesium levels but is less likely the cause in this scenario. Option C, the use of magnesium-containing supplements, can also contribute to hypermagnesemia but is not as common in elderly clients without a history of using such supplements. Option D, history of alcohol use, is less relevant to the development of elevated serum magnesium levels compared to laxative use for chronic constipation.

4. A client is admitted with a diagnosis of septic shock. Which clinical finding requires immediate intervention?

• A. Blood pressure of 90/60 mmHg
• B. Temperature of 100.4°F
• C. Heart rate of 120 beats per minute
• D. Urine output of 30 ml/hour

Correct answer: C

Rationale: In a client with septic shock, a heart rate of 120 beats per minute is a critical clinical finding that requires immediate intervention. A rapid heart rate can indicate worsening sepsis and inadequate tissue perfusion. Correcting the underlying cause of the tachycardia and stabilizing the heart rate is crucial in managing septic shock. The other options, while important, do not represent an immediate threat to the patient's condition. A blood pressure of 90/60 mmHg may be expected in septic shock, a temperature of 100.4°F is mildly elevated, and a urine output of 30 ml/hour, though decreased, may not be an immediate concern in the context of septic shock.

5. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in keeping with the child's dietary restrictions. Which foods are contraindicated for this child?

• A. Wheat products
• B. Foods sweetened with aspartame
• C. High-fat foods
• D. High-calorie foods

Correct answer: B

Rationale: The correct answer is B: Foods sweetened with aspartame. Aspartame should not be consumed by a child with PKU because it is converted to phenylalanine in the body, which can be harmful to individuals with PKU. Choice A (Wheat products) is not specifically contraindicated for PKU. Choice C (High-fat foods) and Choice D (High-calorie foods) are not typically restricted in PKU diets unless they contain high levels of phenylalanine.

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