Nursing Elites

1. Before a client with renal failure undergoes hemodialysis, what should the nurse assess?

• A. Check the client's potassium levels
• B. Review the client's medication list
• C. Assess the client's peripheral pulses
• D. Monitor the client's urine output

Correct answer: A

Rationale: The correct answer is to check the client's potassium levels. Potassium levels are crucial to assess before hemodialysis in a client with renal failure because hyperkalemia (high potassium) is a common complication in these patients. Hemodialysis aims to remove excess potassium from the blood, making it essential to monitor potassium levels to determine the need for appropriate interventions. Reviewing the client's medication list (Choice B) is important for overall care but is not as directly relevant to the immediate concerns before hemodialysis. Assessing peripheral pulses (Choice C) and monitoring urine output (Choice D) are important aspects of nursing assessment but are not as directly related to the specific preparation needed before hemodialysis in a client with renal failure.

2. A client with chronic kidney disease is prescribed a low-potassium diet. Which food should the nurse instruct the client to avoid?

• A. Carrots
• B. White bread
• C. Bananas
• D. Apples

Correct answer: C

Rationale: The correct answer is C: Bananas. Bananas are high in potassium and should be avoided in clients who are on a low-potassium diet due to chronic kidney disease. Foods like apples and white bread are low in potassium and are safer choices. Carrots are also low in potassium and do not need to be avoided in this case.

3. Which medication should the nurse withhold if the client's serum potassium level is 6.2 mEq/L?

• A. Losartan
• B. Spironolactone
• C. Metoprolol
• D. Furosemide

Correct answer: B

Rationale: The correct answer is B: Spironolactone. Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. With potassium levels already elevated at 6.2 mEq/L, withholding Spironolactone is essential to prevent further increase in potassium levels, which could result in dangerous cardiac arrhythmias. Losartan (Choice A) is an angiotensin receptor blocker and does not directly affect potassium levels. Metoprolol (Choice C) is a beta-blocker and also does not impact potassium levels significantly. Furosemide (Choice D) is a loop diuretic that can actually lower potassium levels, so it would not be the medication to withhold in this case.

4. A client reports that the skin around the edges of a wound is red and swollen. What is the nurse's priority intervention?

• A. Monitor for signs of infection
• B. Reinforce the wound dressing
• C. Contact the healthcare provider
• D. Apply a warm compress to the wound

Correct answer: A

Rationale: The correct answer is to monitor for signs of infection. Redness and swelling around a wound are indicative of a potential infection. The priority intervention for the nurse is to closely monitor the wound for further signs of infection, such as increased drainage or fever. Reinforcing the wound dressing may be necessary, but it is not the priority when infection is suspected. Contacting the healthcare provider is important, but the nurse should first assess and monitor the wound to provide comprehensive information when contacting the provider. Applying a warm compress can potentially worsen the infection by promoting bacterial growth, so it is contraindicated in this situation.

5. A client who has been prescribed multiple antihypertensive medications experiences syncope and has a blood pressure of 70/40. What is the rationale for the nurse to hold the next scheduled antihypertensive dose?

• A. Increased urinary clearance of the medications has produced diuresis, lowering the blood pressure.
• B. The antagonistic interaction of the medications has reduced their effectiveness.
• C. The synergistic effect of the medications has resulted in drug toxicity, causing hypotension.
• D. The additive effect of the medications has lowered the blood pressure too much.

Correct answer: D

Rationale: The additive effect of multiple antihypertensive medications can cause hypotension, leading to dangerously low blood pressure. In this scenario, the client experiencing syncope with a blood pressure of 70/40 indicates severe hypotension, likely due to the combined action of the antihypertensive medications. Holding the next scheduled dose is essential to prevent further lowering of blood pressure and potential complications. Choices A, B, and C provide inaccurate explanations and do not align with the client's presentation and the need to manage hypotension caused by the additive effect of the medications.

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