Nursing Elites

1. A client with chronic kidney disease is receiving epoetin alfa (Epogen). Which laboratory value should the nurse monitor to determine the effectiveness of this medication?

• A. Serum creatinine
• B. Hemoglobin
• C. Blood urea nitrogen (BUN)
• D. Platelet count

Correct answer: B

Rationale: The correct answer is B: Hemoglobin. Epoetin alfa (Epogen) is a medication commonly used in clients with chronic kidney disease to stimulate red blood cell production. Monitoring hemoglobin levels is crucial to assess the effectiveness of epoetin alfa therapy. Hemoglobin levels reflect the oxygen-carrying capacity of the blood and indicate if the medication is successfully treating anemia associated with chronic kidney disease. Option A, serum creatinine, is a marker of kidney function, not the primary indicator of epoetin alfa effectiveness. Option C, blood urea nitrogen (BUN), is a measure of kidney function and hydration status. Option D, platelet count, assesses clotting ability and is unrelated to monitoring the effectiveness of epoetin alfa in treating anemia in chronic kidney disease.

2. A client who is terminally ill has a family member who is coping effectively with the situation. Which of the following statements should the nurse identify as an indication of effective coping?

• A. "We still have hope that everything will be okay."
• B. "This is a difficult time, but we are helping each other through this."
• C. "After he comes home, we can plan out a family reunion."
• D. "We don't need to talk about funeral arrangements at this time."

Correct answer: B

Rationale: The correct answer is B because an effective coping strategy involves mutual support and communication within the family. This statement reflects effective coping skills as the family is shown to be helping each other through the difficult time. Choice A is incorrect as maintaining hope does not necessarily indicate effective coping. Choice C focuses on future events and may not address the current situation of coping with a terminally ill family member. Choice D avoids discussing important aspects of end-of-life planning, which may not reflect effective coping with the situation at hand.

3. A client with a terminal illness is being educated by a healthcare provider about her decision to decline resuscitation in her living will. The client asks about the scenario of having difficulty breathing upon arrival at the emergency department.

• A. “We will apply oxygen through a tube in your nose.”
• B. “We will perform resuscitation efforts regardless of your wishes.”
• C. “You will receive only palliative care.”
• D. “We will ensure your comfort measures are met as per your advance directives.”

Correct answer: A

Rationale: Choice A is correct because applying oxygen through a tube in the nose provides comfort and aligns with the client's wishes for palliative care without resuscitation. This intervention can help alleviate breathing difficulties and maintain comfort without initiating full resuscitation efforts, respecting the client's decision. Choice B is incorrect as it goes against the client's expressed wish to decline resuscitation in her living will. Choice C is not the most appropriate response as it does not directly address the client's immediate concern of difficulty breathing and lacks specificity. Choice D, although focusing on comfort measures, is less specific than the correct choice A in addressing the client's immediate need for assistance with breathing.

4. The healthcare provider is educating a client about dietary changes to prevent the recurrence of calcium oxalate kidney stones. Which food should the provider advise the client to avoid?

• A. Spinach
• B. Bananas
• C. Chicken
• D. Rice

Correct answer: A

Rationale: The correct answer is A: Spinach. Spinach is high in oxalate, a compound that can contribute to the formation of calcium oxalate kidney stones. Therefore, advising the client to avoid spinach is crucial in reducing the risk of stone recurrence. Bananas (choice B) are not high in oxalate and do not directly contribute to the formation of calcium oxalate stones, so they do not need to be avoided. Similarly, choices C and D, chicken, and rice, are not typically associated with high oxalate content, making them safe choices and do not need to be avoided specifically to prevent calcium oxalate kidney stones.

5. A client with a history of alcoholism is admitted with confusion and ataxia. The LPN/LVN recognizes that these symptoms may be related to a deficiency in which vitamin?

• A. Vitamin A
• B. Vitamin C
• C. Vitamin D
• D. Vitamin B1 (Thiamine)

Correct answer: D

Rationale: The correct answer is Vitamin B1 (Thiamine). Vitamin B1 deficiency, also known as Thiamine deficiency, is common in clients with a history of alcoholism. Thiamine is essential for proper brain function, and its deficiency can lead to neurological symptoms such as confusion and ataxia. Vitamin A, C, and D deficiencies do not typically present with confusion and ataxia in the context of alcoholism. Vitamin A deficiency mainly affects vision, Vitamin C deficiency leads to scurvy with symptoms like bleeding gums, and Vitamin D deficiency is associated with bone disorders. Therefore, they are not the correct choices in this scenario.

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