Nursing Elites

1. A client with chronic kidney disease is being assessed. Which of the following laboratory values would be most concerning?

• A. Serum creatinine of 3.0 mg/dL
• B. Serum potassium of 6.5 mEq/L
• C. Blood urea nitrogen (BUN) of 45 mg/dL
• D. Hemoglobin of 10 g/dL

Correct answer: B

Rationale: In a client with chronic kidney disease, elevated serum potassium levels (hyperkalemia) are the most concerning finding. Hyperkalemia can lead to life-threatening cardiac dysrhythmias. Monitoring and managing serum potassium levels are crucial in patients with kidney disease to prevent severe complications. While elevated creatinine (Choice A) and BUN (Choice C) are indicative of impaired kidney function, hyperkalemia poses a more immediate threat to the client's health. Hemoglobin levels (Choice D) can be affected by chronic kidney disease but are not as acutely dangerous as severe hyperkalemia.

2. A charge nurse is teaching a newly licensed nurse about the care of a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following statements should the charge nurse identify as an indication that the newly licensed nurse understands the teaching?

• A. I should obtain a specimen for culture and sensitivity after the first dose of an antimicrobial.
• B. MRSA is usually resistant to vancomycin, so another antimicrobial will be prescribed.
• C. I will protect others from exposure when I transport the client outside the room.
• D. To decrease resistance, antimicrobial therapy is discontinued when the client is no longer febrile.

Correct answer: C

Rationale: The correct answer is C. Protecting others from exposure when transporting a client with MRSA is crucial in preventing the spread of infection. This statement demonstrates understanding of infection control measures. Stating that MRSA is usually resistant to vancomycin (choice B) is incorrect; vancomycin is often effective against MRSA. Obtaining a specimen for culture and sensitivity after the first dose of an antimicrobial (choice A) is unnecessary and not indicated. Discontinuing antimicrobial therapy when the client is no longer febrile (choice D) is incorrect because antimicrobial therapy should be completed as prescribed to prevent the development of resistant strains.

3. A client with congestive heart failure (CHF) is receiving furosemide (Lasix). Which laboratory value should the LPN monitor closely while the client is taking this medication?

• A. Sodium
• B. Potassium
• C. Calcium
• D. Magnesium

Correct answer: B

Rationale: The LPN should monitor potassium levels closely while the client is taking furosemide (Lasix) due to the medication's potential to cause hypokalemia. Furosemide is a loop diuretic that can lead to potassium loss through increased urine output. Hypokalemia can result in serious complications such as cardiac dysrhythmias. Monitoring sodium levels (choice A) is important but not as critical as monitoring potassium in this context. Calcium (choice C) and magnesium (choice D) levels are not typically affected by furosemide and are not the priority for monitoring in this scenario.

4. A client with chronic kidney disease is being assessed. Which laboratory value would be most concerning?

• A. Serum creatinine of 3.0 mg/dL
• B. Blood urea nitrogen (BUN) of 45 mg/dL
• C. Serum potassium of 6.5 mEq/L
• D. Hemoglobin of 10 g/dL

Correct answer: C

Rationale: In a client with chronic kidney disease, an elevated serum potassium level (hyperkalemia) is the most concerning finding. Hyperkalemia can lead to life-threatening cardiac dysrhythmias due to its effect on the electrical conduction system of the heart. Monitoring and managing serum potassium levels are crucial in patients with chronic kidney disease to prevent serious complications. While elevated serum creatinine (Choice A) and Blood Urea Nitrogen (BUN) levels (Choice B) indicate impaired kidney function, hyperkalemia poses an immediate risk of cardiac complications. Hemoglobin levels (Choice D) are typically lower in chronic kidney disease due to decreased erythropoietin production, but they do not present an immediate life-threatening risk like hyperkalemia.

5. How should the nurse transcribe the dosage of this medication on the client's medical record?

• A. 0.3 mg
• B. 0.3 mg
• C. 0.30 mg
• D. 3/10 mg

Correct answer: B

Rationale: The correct way to transcribe the dosage of three tenths of a milligram of levothyroxine IV STAT is 0.3 mg. When expressing decimals less than 1, there should be a leading zero before the decimal point. Choice A is incorrect (.3 mg) because it lacks the leading zero. Choice C (0.30 mg) is incorrect as it includes a trailing zero after the decimal point, which is unnecessary. Choice D (3/10 mg) is incorrect as it presents the dosage as a fraction, which is not the standard format for transcribing medication dosages. Therefore, B (0.3 mg) is the most appropriate and accurate way to document this prescription on the client's medical record.

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