Nursing Elites

1. A client with chronic renal failure is receiving sodium polystyrene sulfonate (Kayexalate). The nurse should monitor the client for which of the following?

• A. Hyponatremia.
• B. Hypokalemia.
• C. Hyperkalemia.
• D. Hypocalcemia.

Correct answer: C

Rationale: Correct Answer: The correct answer is C, 'Hyperkalemia.' Sodium polystyrene sulfonate (Kayexalate) is a medication used to treat high potassium levels (hyperkalemia) by exchanging sodium ions for potassium ions in the intestines, leading to potassium removal from the body. Therefore, the nurse should monitor the client for changes in potassium levels to assess the effectiveness of the medication and prevent potential complications related to hyperkalemia. Choice A, 'Hyponatremia,' is incorrect as Kayexalate does not primarily affect sodium levels. Choice B, 'Hypokalemia,' is incorrect as Kayexalate is used to treat high potassium levels, not low. Choice D, 'Hypocalcemia,' is incorrect as Kayexalate does not directly impact calcium levels.

2. In a patient with asthma, which of the following is the most important indicator of respiratory function?

• A. Oxygen saturation.
• B. Respiratory rate.
• C. Arterial blood gases.
• D. Peak expiratory flow rate.

Correct answer: D

Rationale: The peak expiratory flow rate is the most important indicator of respiratory function in asthma because it measures how quickly air can be exhaled, reflecting the severity of airflow limitation. Oxygen saturation (Choice A) is important in assessing oxygenation, but it does not directly reflect respiratory function. Respiratory rate (Choice B) can provide information on breathing patterns but does not quantify airflow limitation. Arterial blood gases (Choice C) give information about gas exchange but are not as specific for assessing asthma control and severity as peak expiratory flow rate.

3. A nurse is assessing a postoperative client on an hourly basis. The nurse notes that the client’s urine output for the past hour was 25 mL. Based on this finding, the nurse first:

• A. Calls the physician
• B. Increases the rate of the IV infusion
• C. Checks the client’s overall intake and output record
• D. Administers a 250-mL bolus of normal saline solution (0.9%)

Correct answer: C

Rationale: Clients are at risk of hypovolemia postoperatively, and decreased urine output can be an early sign. However, to accurately interpret this finding, the nurse must assess the overall fluid balance by checking the client’s intake and output records. Increasing the IV infusion rate or administering a bolus of normal saline solution without a physician's order would not be appropriate as these interventions require a prescription. The physician should be notified once the nurse has collected all necessary assessment data, including fluid status and vital signs.

4. A client with chronic renal failure is receiving erythropoietin therapy. The nurse should assess the client for which of the following side effects?

• A. Hypotension.
• B. Hypertension.
• C. Hyperglycemia.
• D. Hypercalcemia.

Correct answer: B

Rationale: The correct answer is B: Hypertension. Erythropoietin therapy can lead to an increase in blood pressure, making hypertension a common side effect that the nurse should closely monitor. Hypotension (choice A) is not typically associated with erythropoietin therapy. Hyperglycemia (choice C) and hypercalcemia (choice D) are not commonly linked to erythropoietin therapy in clients with chronic renal failure, making them incorrect choices.

5. An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that his tongue is somewhat cracked, and his eyeballs are sunken into his head. What nursing intervention is indicated?

• A. Help the client determine ways to increase his fluid intake.
• B. Obtain an appointment for the client to see a pulmonologist.
• C. Schedule an appointment with a nutritionist to assess the client's diet.
• D. Encourage the client to slightly increase his use of oxygen at night and to always use humidified oxygen.

Correct answer: A

Rationale: The correct nursing intervention in this scenario is to assist the client in finding ways to increase his fluid intake. Clients with COPD, including emphysema, should aim to consume at least three liters of fluids per day to help keep their mucus thin. As the disease progresses, these clients may decrease fluid intake due to various reasons. Suggesting creative methods, such as having disposable fruit juices readily available, can help the client meet this goal. Option B is incorrect as seeing an ear, nose, and throat specialist is not directly related to the client's symptoms. Option C is not the priority in this case, as the main concern is addressing the client's dehydration. Option D does not address the immediate need for managing the client's dehydration and is not the most appropriate intervention at this time.

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