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. When administering ceftriaxone sodium (Rocephin) intravenously to a client, what finding requires the most immediate intervention by the nurse?

• A. Stridor
• B. Nausea
• C. Headache
• D. Pruritus

Correct answer: A

Rationale: The correct answer is A: Stridor. Stridor is a high-pitched sound that indicates airway obstruction. When administering ceftriaxone sodium (Rocephin) intravenously, if the client develops stridor, it is a medical emergency requiring immediate intervention to maintain a patent airway. Nausea, headache, and pruritus are important to assess, but they do not pose an immediate threat to the client's airway and would not require the same level of urgent intervention as stridor.

3. The client with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen. Which laboratory value is most concerning?

• A. Serum sodium of 135 mEq/L
• B. Serum potassium of 4.0 mEq/L
• C. Serum bicarbonate of 18 mEq/L
• D. Serum glucose of 300 mg/dl

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L is concerning in a client with COPD receiving supplemental oxygen as it indicates metabolic acidosis, which can occur due to the body compensating for chronic respiratory acidosis. This condition requires immediate intervention to restore the acid-base balance. Choice A, serum sodium of 135 mEq/L, is within normal range (135-145 mEq/L) and not directly related to COPD or oxygen therapy. Choice B, serum potassium of 4.0 mEq/L, falls within the normal range (3.5-5.0 mEq/L) and is not typically affected by COPD or oxygen therapy. Choice D, serum glucose of 300 mg/dl, though elevated, is not directly related to COPD or oxygen therapy and would require management but is not the most concerning value in this scenario.

4. During a clinic visit, a client with a kidney transplant asks, 'What will happen if chronic rejection develops?' Which response is best for the nurse to provide?

• A. Dialysis would need to be resumed if chronic rejection becomes a reality.
• B. Immunosuppressive therapy would be intensified.
• C. A second transplant would be scheduled immediately.
• D. We would monitor your kidney function closely.

Correct answer: A

Rationale: The best response for the nurse to provide is that dialysis would need to be resumed if chronic rejection becomes a reality. Chronic rejection of a transplanted kidney can lead to kidney failure, necessitating the need for dialysis until another transplant is possible. Choice B is incorrect because although immunosuppressive therapy may be adjusted, the immediate concern is the potential need for dialysis. Choice C is incorrect because scheduling a second transplant immediately is not typically the first step following chronic rejection. Choice D is also incorrect as close monitoring of kidney function is essential but does not address the immediate need for dialysis if chronic rejection occurs.

5. A client with a history of congestive heart failure is admitted with shortness of breath. Which nursing intervention should the nurse implement first?

• A. Elevate the head of the bed.
• B. Administer prescribed diuretic therapy.
• C. Monitor the client's oxygen saturation.
• D. Assess the client's level of consciousness.

Correct answer: A

Rationale: The correct answer is to elevate the head of the bed. Elevating the head of the bed is crucial in improving oxygenation in clients with congestive heart failure and shortness of breath by reducing venous return to the heart and decreasing fluid overload in the lungs. This intervention helps to alleviate the client's breathing difficulty. Administering diuretic therapy (Choice B) may be necessary but is not the initial priority. Monitoring oxygen saturation (Choice C) is important but should come after ensuring proper positioning. Assessing the client's level of consciousness (Choice D) is essential but is not the first intervention needed for a client experiencing respiratory distress.

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