Nursing Elites

1. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which laboratory value should be monitored closely?

• A. Arterial blood gas (ABG) values
• B. Serum potassium level
• C. Serum sodium level
• D. Serum magnesium level

Correct answer: B

Rationale: The correct answer is B: Serum potassium level. In COPD, especially when the client is receiving diuretics or corticosteroids, monitoring serum potassium levels is crucial. These medications can lead to potassium loss, potentially causing hypokalemia. Arterial blood gas (choice A) values are important in assessing respiratory status but are not the primary concern related to medication side effects. Serum sodium (choice C) and magnesium (choice D) levels are also important, but in the context of COPD exacerbation and medication effects, potassium monitoring takes precedence.

2. Following routine diagnostic tests, a client who is symptom-free is diagnosed with Paget's disease. Client teaching should be directed toward what important goal for this client?

• A. Maintain adequate cardiac output.
• B. Promote adequate tissue perfusion.
• C. Promote rest and sleep.
• D. Reduce the risk for injury.

Correct answer: D

Rationale: In Paget's disease, bone remodeling is affected, leading to increased risk for fractures. Therefore, the primary goal of client teaching should focus on reducing the risk for injury. Choices A and B are not directly related to the primary concern of Paget's disease, which is bone fractures. Choice C, promoting rest and sleep, is important for overall health but is not the priority when considering the specific risks associated with Paget's disease.

3. The nurse is caring for a client with chronic kidney disease (CKD). Which laboratory value should be reported to the healthcare provider immediately?

• A. Serum creatinine of 2.0 mg/dl
• B. Hemoglobin of 10 g/dl
• C. Potassium of 6.5 mEq/L
• D. Blood glucose of 150 mg/dl

Correct answer: C

Rationale: The correct answer is C. A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, and requires immediate intervention to prevent cardiac complications. Hyperkalemia can lead to life-threatening arrhythmias, making it crucial to notify the healthcare provider promptly. Choices A, B, and D do not indicate immediate life-threatening conditions. Elevated serum creatinine levels are expected in CKD, a hemoglobin level of 10 g/dl is within a reasonable range, and a blood glucose level of 150 mg/dl is not acutely concerning in this context.

4. The nurse and an unlicensed assistive personnel (UAP) are providing care for a client with a nasogastric tube (NGT) when the client begins to vomit. How should the nurse manage this situation?

• A. Direct the UAP to measure the emesis while the nurse irrigates the NGT
• B. Stop the NGT feed and notify the healthcare provider
• C. Increase the NGT suction pressure
• D. Elevate the head of the bed

Correct answer: A

Rationale: During vomiting in a client with an NGT, it is essential for the nurse to direct the UAP to measure the emesis to monitor the output. This helps in assessing the client's condition and response to treatment. Meanwhile, irrigating the NGT can be beneficial to relieve any obstruction that might be contributing to the vomiting. Stopping the NGT feed and notifying the healthcare provider (choice B) is important but not the immediate action needed. Increasing the NGT suction pressure (choice C) is unnecessary and can lead to complications. Elevating the head of the bed (choice D) is a general intervention to prevent aspiration but may not address the immediate issue of managing the vomiting episode and potential tube obstruction.

5. The nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory value requires immediate intervention?

• A. Serum glucose of 300 mg/dL
• B. Serum potassium of 4.5 mEq/L
• C. Serum bicarbonate of 15 mEq/L
• D. Serum pH of 7.28

Correct answer: D

Rationale: A serum pH of 7.28 indicates metabolic acidosis in a client with diabetic ketoacidosis (DKA), requiring immediate intervention. In DKA, the body produces excess ketones, leading to acidosis. Monitoring and correcting the pH level is crucial in managing DKA. Serum glucose levels may be high in DKA, but the immediate concern is correcting the acidosis to prevent complications. Serum potassium and bicarbonate levels are also important but not as immediately critical as correcting the acidosis in DKA.

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