a client with chronic kidney disease ckd is scheduled for a hemodialysis session which laboratory value should the nurse report to the healthcare prov

HESI RN

HESI 799 RN Exit Exam

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 who had a gestational trophoblastic disease (GTD) evacuated 2 days ago is being monitored for choriocarcinoma. She lives in a rural area, and her husband takes the family car to work daily, leaving her without transportation during the day. What intervention is most important for the nurse to implement?

A. Teach the client about the use of a home pregnancy test.
B. Schedule a weekly home visit to draw hCG values.
C. Make a 5-week follow-up appointment with the healthcare provider.
D. Begin chemotherapy administration during the first home visit.

Correct answer: B

Rationale: Scheduling weekly home visits to monitor hCG levels is critical for early detection of choriocarcinoma, a potential complication of GTD. Choice A is incorrect because a home pregnancy test is not the appropriate method to monitor for choriocarcinoma. Choice C is less frequent than necessary for close monitoring. Choice D is incorrect as chemotherapy administration should be based on confirmed diagnosis and treatment plan, not initiated during the first home visit.

3. A woman with an anxiety disorder calls her obstetrician's office and tells the nurse of increased anxiety since the normal vaginal delivery of her son three weeks ago. Since she is breastfeeding, she stopped taking her antianxiety medications, but thinks she may need to start taking them again because of her increased anxiety. What response is best for the nurse to provide this woman?

A. Describe the transmission of drugs to the infant through breast milk
B. Encourage her to use stress-relieving alternatives, such as deep breathing exercises
C. Inform her that some antianxiety medications are safe to take while breastfeeding
D. Explain that anxiety is a normal response for the mother of a 3-week-old.

Correct answer: C

Rationale: There are several antianxiety medications that are not contraindicated for breastfeeding mothers, so it is important to inform her of this option.

4. A client with a history of chronic kidney disease (CKD) is receiving erythropoietin therapy. Which laboratory value should the nurse monitor closely?

A. Serum potassium level
B. White blood cell count
C. Hemoglobin level
D. Serum calcium level

Correct answer: A

Rationale: The correct answer is A: Serum potassium level. In a client receiving erythropoietin therapy for chronic kidney disease, monitoring serum potassium levels is crucial due to the risk of hyperkalemia. Erythropoietin can stimulate red blood cell production, leading to an increased demand for potassium. Monitoring potassium levels helps prevent complications associated with hyperkalemia. Choices B, C, and D are incorrect because erythropoietin therapy specifically impacts potassium levels, not white blood cell count, hemoglobin level, or serum calcium level.

5. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which clinical finding requires immediate intervention?

A. Serum glucose of 300 mg/dL
B. Serum potassium of 5.5 mEq/L
C. Serum bicarbonate of 18 mEq/L
D. Positive urine ketones

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L indicates metabolic acidosis in a client with DKA, requiring immediate intervention. In DKA, the body produces excess ketones, leading to metabolic acidosis, which is reflected by a low serum bicarbonate level. Correcting the low serum bicarbonate is crucial to normalize the metabolic acidosis and improve the client's condition. While elevated serum glucose (choice A) and urine ketones (choice D) are characteristic of DKA, addressing the metabolic acidosis takes precedence. Serum potassium (choice B) levels may also need monitoring and management, but correcting the acidosis is the priority to prevent complications like cardiovascular collapse.