Nursing Elites

1. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which laboratory value should be closely monitored before the procedure?

• A. Serum creatinine of 2.0 mg/dl
• B. Serum potassium of 5.5 mEq/L
• C. Serum calcium of 8.0 mg/dl
• D. Hemoglobin of 12 g/dl

Correct answer: B

Rationale: A serum potassium level of 5.5 mEq/L is concerning in a client with ESRD scheduled for hemodialysis as it indicates hyperkalemia, which can lead to serious cardiac complications. Hyperkalemia can be exacerbated during hemodialysis, making it crucial to closely monitor serum potassium levels before the procedure. Monitoring serum creatinine, serum calcium, or hemoglobin levels is important in managing ESRD but is not the immediate focus before hemodialysis. Therefore, option B is the correct choice.

2. After a third hospitalization 6 months ago, a client is admitted to the hospital with ascites and malnutrition. The client is drowsy but responding to verbal stimuli and reports recently spitting up blood. What assessment finding warrants immediate intervention by the nurse?

• A. Bruises on arms and legs
• B. Round and tight abdomen
• C. Pitting edema in lower legs
• D. Capillary refill of 8 seconds

Correct answer: D

Rationale: In this situation, the client's capillary refill of 8 seconds is the assessment finding that warrants immediate intervention by the nurse. A capillary refill greater than 3 to 5 seconds indicates poor perfusion, which could be a sign of inadequate circulation and oxygenation. Checking capillary refill is a quick and useful way to assess peripheral perfusion. Bruises on arms and legs may indicate a bleeding disorder but are not as urgent as addressing poor perfusion. A round and tight abdomen could suggest ascites, which is already known in this case. Pitting edema in lower legs is a common finding in malnutrition and ascites but does not require immediate intervention as poor capillary refill does.

3. A client with end-stage renal disease (ESRD is scheduled for hemodialysis. Which laboratory value should the nurse monitor closely before the procedure?

• A. Serum creatinine
• B. Serum potassium
• C. Serum sodium
• D. Hemoglobin

Correct answer: B

Rationale: Before hemodialysis in a client with end-stage renal disease (ESRD), monitoring serum potassium closely is crucial. ESRD patients are at risk of hyperkalemia, which can lead to severe cardiac complications. Checking serum potassium levels helps in assessing and managing this electrolyte imbalance. Serum creatinine (Choice A) is a marker of kidney function but is not the most critical value to monitor before hemodialysis. Serum sodium (Choice C) may be affected in renal disease, but potassium is a more crucial electrolyte to monitor. Hemoglobin (Choice D) is essential for assessing anemia in ESRD but is not the primary focus before hemodialysis.

4. The nurse is reviewing a client's electrocardiogram and determines the PR interval (PRI) is prolonged. What does this finding indicate?

• A. Initiation of the impulses from a location outside the SA node
• B. Inability of the SA node to initiate an impulse at the normal rate
• C. Increased conduction time from the SA node to the AV junction
• D. Interference with the conduction through one or both ventricles

Correct answer: C

Rationale: When the PR interval is prolonged, it signifies an increased conduction time from the SA node through the AV junction. This finding is characteristic of a first-degree heart block where there is a delay in the electrical conduction at the level of the AV node. Choices A, B, and D are incorrect as they do not accurately reflect the significance of a prolonged PR interval.

5. A male client reports the onset of numbness and tingling in his fingers and around his mouth. Which lab test is important for the nurse to review before contacting the healthcare provider?

• A. Capillary glucose
• B. Urine specific gravity
• C. Serum calcium
• D. White blood cell count

Correct answer: C

Rationale: The correct answer is C: Serum calcium. Numbness and tingling in the fingers and around the mouth are indicative of hypocalcemia. Serum calcium levels should be reviewed as they play a crucial role in diagnosing and managing hypocalcemia. Option A, capillary glucose, is not relevant to the symptoms described. Option B, urine specific gravity, is not typically used to assess numbness and tingling. Option D, white blood cell count, is unrelated to the symptoms presented by the client.

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