Nursing Elites

1. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which laboratory value is most concerning?

• A. Serum glucose of 300 mg/dl
• B. Serum bicarbonate of 18 mEq/L
• C. Serum potassium of 5.5 mEq/L
• D. Serum sodium of 135 mEq/L

Correct answer: C

Rationale: A serum potassium level of 5.5 mEq/L is concerning in a client with DKA as it may indicate worsening hyperkalemia, requiring immediate intervention. Elevated serum potassium levels can lead to life-threatening cardiac arrhythmias. While elevated glucose and low bicarbonate are characteristic of DKA, hyperkalemia poses a higher immediate risk. Serum sodium within the normal range is not typically a primary concern in DKA.

2. The nurse is caring for a client with chronic heart failure who is receiving furosemide (Lasix). Which laboratory value requires immediate intervention?

• A. Serum potassium of 3.0 mEq/L
• B. Serum sodium of 135 mEq/L
• C. Serum creatinine of 1.8 mg/dL
• D. Blood glucose of 200 mg/dL

Correct answer: A

Rationale: A serum potassium level of 3.0 mEq/L is most concerning in a client receiving furosemide as it indicates hypokalemia, which requires immediate intervention. Hypokalemia can lead to serious cardiac arrhythmias, which can be life-threatening. Serum sodium of 135 mEq/L and serum creatinine of 1.8 mg/dL are within normal ranges and do not require immediate intervention in this case. Blood glucose of 200 mg/dL is elevated but does not pose an immediate threat to the client's life in the context of heart failure and furosemide therapy.

3. A client with chronic kidney disease (CKD) is scheduled for a hemodialysis session. Which laboratory value should the nurse report to the healthcare provider before the procedure?

• A. Serum potassium of 5.5 mEq/L
• B. Blood urea nitrogen (BUN) of 40 mg/dl
• C. Serum potassium of 6.0 mEq/L
• D. Serum creatinine of 2.5 mg/dl

Correct answer: C

Rationale: A serum potassium level of 6.0 mEq/L is dangerously high for a client with chronic kidney disease (CKD) scheduled for hemodialysis. High potassium levels can lead to cardiac complications such as arrhythmias. Therefore, it is crucial to report this value to the healthcare provider before the procedure to prevent any potential serious complications. Choices A, B, and D are not as critical in the context of preparing for a hemodialysis session. Serum potassium levels above 6.0 mEq/L require immediate attention to ensure patient safety.

4. A 66-year-old woman is retiring and will no longer have health insurance through her place of employment. Which agency should the client be referred to by the employee health nurse for health insurance needs?

• A. Woman, Infants, and Children program
• B. Medicaid
• C. Medicare
• D. Consolidated Omnibus Budget Reconciliation Act provision

Correct answer: C

Rationale: The correct answer is C: Medicare. Title XVII of the Social Security Act of 1965 created the Medicare Program to provide medical insurance for individuals who are 65 years or older, disabled, or have permanent kidney failure. Medicare is the appropriate agency to refer a 66-year-old woman who is retiring and losing her employment-based health insurance. Choice A, the Woman, Infants, and Children program, is not suitable for this scenario as it provides assistance for low-income pregnant women, breastfeeding women, and young children. Choice B, Medicaid, is a program that helps individuals with low income and resources cover medical costs, which may not be applicable to this woman's situation. Choice D, the Consolidated Omnibus Budget Reconciliation Act provision, known as COBRA, allows employees to continue their group health insurance coverage after leaving their job but may not be the best option for this woman in this case.

5. A client with hypertension receives a prescription for enalapril, an angiotensin-converting enzyme inhibitor (ACEI). Which instruction should the nurse include in the medication teaching plan?

• A. Increase intake of potassium-rich foods
• B. Report increased bruising or bleeding
• C. Stop medication if a cough develops
• D. Limit intake of leafy green vegetables

Correct answer: B

Rationale: The correct instruction for the nurse to include in the medication teaching plan for a client receiving enalapril, an ACE inhibitor, is to 'Report increased bruising or bleeding.' ACE inhibitors can cause thrombocytopenia, which can lead to an increased risk of bruising and bleeding. Monitoring and reporting these symptoms promptly are essential to prevent complications. Choices A, C, and D are incorrect because increasing potassium-rich foods, stopping medication if a cough develops, and limiting intake of leafy green vegetables are not directly related to the common side effects or actions of ACE inhibitors.

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