Nursing Elites

1. A client with chronic kidney disease (CKD) is receiving epoetin alfa (Epogen). Which laboratory value should the nurse monitor closely?

• A. Hemoglobin
• B. White blood cell count
• C. Serum potassium
• D. Serum creatinine

Correct answer: C

Rationale: The correct answer is C: Serum potassium. When a client with chronic kidney disease (CKD) is receiving epoetin alfa (Epogen), monitoring serum potassium levels closely is crucial. Epoetin alfa stimulates red blood cell production, which can lead to an increase in potassium levels. Hyperkalemia is a potential risk in these clients. Monitoring hemoglobin levels (choice A) is important in assessing the effectiveness of epoetin alfa therapy, but it is not the laboratory value that poses an immediate risk related to the medication. White blood cell count (choice B) and serum creatinine (choice D) are not directly affected by epoetin alfa therapy and are not the priority laboratory values to monitor in this case.

2. A client with hypertension receives a prescription for enalapril, an angiotensin-converting enzyme inhibitor. What instruction should the nurse include in the medication teaching plan?

• A. Increase intake of potassium-rich foods
• B. Report increased bruising or bleeding
• C. Stop medication if a cough develops
• D. Limit intake of leafy green vegetables

Correct answer: B

Rationale: The correct answer is B: 'Report increased bruising or bleeding.' Enalapril, an ACE inhibitor, can lead to thrombocytopenia, a condition characterized by a low platelet count, which increases the risk of bruising and bleeding. Instructing the client to report any signs of increased bruising or bleeding is crucial for monitoring and managing this potential side effect. Choices A, C, and D are incorrect: A - Increasing potassium-rich foods is not directly related to the side effects of enalapril. C - Developing a cough is a common side effect of ACE inhibitors, but it does not warrant stopping the medication unless advised by a healthcare provider. D - Limiting intake of leafy green vegetables is not necessary with enalapril unless specifically instructed by a healthcare provider for individual reasons.

3. The nurse is caring for a client with a chest tube following a pneumothorax. Which finding requires immediate intervention?

• A. Oxygen saturation of 94%
• B. Crepitus around the insertion site
• C. Subcutaneous emphysema
• D. Drainage of 50 ml per hour

Correct answer: C

Rationale: Subcutaneous emphysema is the most critical finding requiring immediate intervention in a client with a chest tube following a pneumothorax. It may indicate a pneumothorax recurrence or air leak, which can lead to respiratory compromise. Oxygen saturation of 94% is slightly low but may not require immediate intervention. Crepitus around the insertion site can be a normal finding post-procedure. Drainage of 50 ml per hour is within the expected range for a chest tube output and does not indicate an immediate concern.

4. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which intervention should the nurse implement first?

• A. Elevate the head of the bed.
• B. Administer oxygen therapy as prescribed.
• C. Assess the client's oxygen saturation.
• D. Obtain an arterial blood gas (ABG) sample.

Correct answer: C

Rationale: Assessing the client's oxygen saturation is the first priority in managing a client with COPD receiving supplemental oxygen to ensure adequate oxygenation. Monitoring oxygen saturation levels helps in determining the effectiveness of the oxygen therapy and if adjustments are needed. Elevating the head of the bed can help with breathing but is not the first priority. Administering oxygen therapy as prescribed is important, but assessing the current oxygen saturation comes before administering more oxygen. Obtaining an arterial blood gas (ABG) sample may provide valuable information, but it is not the initial intervention needed in this situation.

5. During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action should the nurse take first?

• A. Give the client 4 ounces of orange juice
• B. Call 911 to summon emergency assistance
• C. Check the client for lacerations or fractures
• D. Assess client's blood sugar level

Correct answer: C

Rationale: The correct first action for the nurse to take after an elderly client with diabetes slips and falls is to check the client for lacerations or fractures. This is crucial to assess for any immediate physical injuries that may need immediate attention. Giving orange juice or assessing the blood sugar level may be important later but checking for injuries takes precedence to ensure the client's safety and well-being. Calling 911 should be considered if there are severe injuries or if the client is in distress, but checking for lacerations or fractures is the priority at the moment.

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