Nursing Elites

1. A client with chronic kidney disease (CKD) is scheduled for a hemodialysis session. Which laboratory value should the nurse report to the healthcare provider before the procedure?

• A. Serum potassium of 5.5 mEq/L
• B. Blood urea nitrogen (BUN) of 40 mg/dl
• C. Serum potassium of 6.0 mEq/L
• D. Serum creatinine of 2.5 mg/dl

Correct answer: C

Rationale: A serum potassium level of 6.0 mEq/L is dangerously high for a client with chronic kidney disease (CKD) scheduled for hemodialysis. High potassium levels can lead to cardiac complications such as arrhythmias. Therefore, it is crucial to report this value to the healthcare provider before the procedure to prevent any potential serious complications. Choices A, B, and D are not as critical in the context of preparing for a hemodialysis session. Serum potassium levels above 6.0 mEq/L require immediate attention to ensure patient safety.

2. A client with a history of myocardial infarction is experiencing chest pain. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Administer aspirin as prescribed.
• C. Administer nitroglycerin sublingually as prescribed.
• D. Obtain an electrocardiogram (ECG).

Correct answer: A

Rationale: Administering oxygen therapy is the initial priority in managing chest pain in a client with a history of myocardial infarction. Oxygen therapy helps improve oxygenation, which is crucial in reducing myocardial damage. While administering aspirin and nitroglycerin are essential interventions in the treatment of myocardial infarction, oxygen therapy takes precedence because it addresses the immediate need for oxygen supply to the heart muscle. Obtaining an ECG is important but can be done after ensuring adequate oxygenation.

3. A client with cirrhosis is admitted with hepatic encephalopathy. Which clinical finding is most concerning?

• A. Confusion and altered mental status
• B. Increased abdominal girth
• C. Yellowing of the skin
• D. Peripheral edema

Correct answer: A

Rationale: Confusion and altered mental status are the most concerning clinical findings in a client with hepatic encephalopathy. These symptoms indicate worsening liver function and potential neurological complications, requiring immediate medical attention. Increased abdominal girth may suggest ascites, yellowing of the skin can indicate jaundice, and peripheral edema may be related to fluid retention, but in the context of hepatic encephalopathy, confusion and altered mental status take precedence due to the risk of rapid deterioration and the need for prompt management.

4. A female client reports that her hair is becoming coarse and breaking off, the outer part of her eyebrows has disappeared, and her eyes are all puffy. Which follow-up question is best for the nurse to ask?

• A. Is there a history of female baldness in your family?
• B. Are you under any unusual stress at home or work?
• C. Do you work with hazardous chemicals?
• D. Have you noticed any changes in your fingernails?

Correct answer: D

Rationale: The correct answer is D because the manifestations reported by the client, such as coarse hair, missing eyebrows, and puffy eyes, are indicative of hypothyroidism. Changes in the fingernails, such as brittle or pitted nails, can also be associated with hypothyroidism. Option A is incorrect as female baldness is not directly related to the reported symptoms. Option B is less relevant as stress typically does not cause these specific symptoms. Option C is also less relevant as exposure to hazardous chemicals would present with different symptoms.

5. The practical nurse (PN) is assigned to work with three registered nurses (RNs) who are caring for neurologically compromised clients. The client with which change in status is best to assign to the PN?

• A. Diabetic ketoacidosis with a Glasgow Coma Scale score change from 10 to 7.
• B. Myxedema coma with a blood pressure change from 80/50 to 70/40.
• C. Viral meningitis with a temperature change from 101°F to 102°F.
• D. Subdural hematoma with a blood pressure change from 150/80 to 170/60.

Correct answer: C

Rationale: The client with viral meningitis and a temperature change is the most stable and appropriate for assignment to the PN. A change in temperature from 101°F to 102°F is not as critical as changes in Glasgow Coma Scale score, blood pressure, or wider blood pressure variations. The other clients require more complex monitoring and intervention due to their critical changes in status.

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