Nursing Elites

1. A client with chronic renal failure is prescribed epoetin alfa (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Decreased blood pressure.
• C. Improved hemoglobin levels.
• D. Stable potassium levels.

Correct answer: C

Rationale: Epoetin alfa is a medication that stimulates red blood cell production. Therefore, in a client with chronic renal failure, an effective outcome of epoetin alfa therapy would be an improvement in hemoglobin levels. This indicates that the medication is working as intended by addressing anemia, a common complication of chronic renal failure. Increased urine output (choice A) is not directly related to the action of epoetin alfa. Decreased blood pressure (choice B) is not a primary expected outcome of epoetin alfa therapy. Stable potassium levels (choice D) are important but not a direct indicator of the effectiveness of epoetin alfa in this context.

2. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should the nurse monitor to determine the effectiveness of the medication?

• A. Platelet count.
• B. Prothrombin time (PT) and international normalized ratio (INR).
• C. Activated partial thromboplastin time (aPTT).
• D. Fibrinogen level.

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of warfarin (Coumadin) therapy. These tests help assess the clotting time and the desired anticoagulant effect of the medication. Monitoring PT and INR levels is crucial to ensure that the client is within the therapeutic range, reducing the risk of bleeding or clotting complications associated with warfarin therapy. Platelet count (Choice A) measures the number of platelets in the blood and is not specific for monitoring warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice C) is more commonly used to monitor heparin therapy, not warfarin. Fibrinogen level (Choice D) assesses the amount of fibrinogen in the blood and is not a specific test for monitoring warfarin therapy.

3. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

4. A client is admitted with diabetic ketoacidosis (DKA). Which assessment finding requires immediate intervention?

• A. Fruity breath odor.
• B. Blood glucose of 450 mg/dL.
• C. Deep, rapid respirations.
• D. Serum potassium of 5.2 mEq/L.

Correct answer: C

Rationale: The correct answer is C: Deep, rapid respirations (Kussmaul breathing). This is a sign of severe acidosis commonly seen in diabetic ketoacidosis (DKA) and requires immediate intervention. Kussmaul breathing helps to compensate for the metabolic acidosis by blowing off carbon dioxide. Prompt intervention is necessary to prevent further deterioration and potential respiratory failure. Fruity breath odor (Choice A) is a classic sign of DKA but does not require immediate intervention. While a blood glucose level of 450 mg/dL (Choice B) is high, it does not pose an immediate threat to the client's life. Serum potassium of 5.2 mEq/L (Choice D) is slightly elevated but not the most critical finding that requires immediate intervention in this scenario.

5. A client who delivered a 7-pound infant 12 hours ago is complaining of a severe headache. The client's blood pressure is 110/70, respiratory rate is 18 breaths/minute, heart rate is 74 beats/minute, and temperature is 98.6º F. The client's fundus is firm and one fingerbreadth above the umbilicus. What action should the healthcare team implement first?

• A. Notify the healthcare provider of the assessment findings.
• B. Determine if the client received anesthesia during delivery.
• C. Assign a licensed nurse to reassess the client's vital signs.
• D. Obtain a STAT hemoglobin and hematocrit.

Correct answer: B

Rationale: The correct action to implement first is to determine if the client received anesthesia during delivery. Anesthesia can be a potential cause of postpartum headaches. This information is crucial in assessing and managing the client's condition effectively before considering other interventions. It helps in identifying possible contributing factors to the client's complaint of a severe headache and guides the healthcare team in providing appropriate care and treatment.

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