Nursing Elites

1. A female client receives a prescription for alendronate sodium (Fosamax) to treat her newly diagnosed osteoporosis. What instruction should the nurse include in the client's teaching plan?

• A. Take on an empty stomach with a full glass of water.
• B. Take with food to avoid stomach upset.
• C. Take before bedtime with a light snack.
• D. Take with milk to enhance absorption.

Correct answer: A

Rationale: The correct answer is to take alendronate on an empty stomach with a full glass of water. This instruction is essential to ensure proper absorption and prevent esophageal irritation. Taking alendronate with food, before bedtime with a light snack, or with milk can interfere with its absorption and effectiveness, leading to potential side effects or reduced therapeutic benefits.

2. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which assessment finding is most concerning?

• A. Bradycardia
• B. Muscle weakness
• C. Peaked T waves on the ECG
• D. Decreased deep tendon reflexes

Correct answer: C

Rationale: The correct answer is C: Peaked T waves on the ECG. In hyperkalemia, elevated potassium levels can affect the heart's electrical activity, leading to changes on the ECG such as peaked T waves. This finding is concerning as it can progress to serious cardiac arrhythmias, including ventricular tachycardia and fibrillation. Bradycardia (choice A) and decreased deep tendon reflexes (choice D) are not typically associated with hyperkalemia. While muscle weakness (choice B) can occur in hyperkalemia due to its effect on neuromuscular function, the most concerning assessment finding indicating the need for immediate intervention in this scenario is peaked T waves on the ECG.

3. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in keeping with the child's dietary restrictions. Which foods are contraindicated for this child?

• A. Wheat products
• B. Foods sweetened with aspartame
• C. High-fat foods
• D. High-calorie foods

Correct answer: B

Rationale: The correct answer is B: Foods sweetened with aspartame. Aspartame should not be consumed by a child with PKU because it is converted to phenylalanine in the body, which can be harmful to individuals with PKU. Choice A (Wheat products) is not specifically contraindicated for PKU. Choice C (High-fat foods) and Choice D (High-calorie foods) are not typically restricted in PKU diets unless they contain high levels of phenylalanine.

4. A client with liver cirrhosis and ascites is admitted with jaundice. Which laboratory value is most concerning to the nurse?

• A. Serum albumin of 3.0 g/dl
• B. Bilirubin of 3.0 mg/dl
• C. Ammonia level of 80 mcg/dl
• D. Prothrombin time of 18 seconds

Correct answer: C

Rationale: An ammonia level of 80 mcg/dl is elevated and concerning in a client with liver cirrhosis, as it may indicate hepatic encephalopathy. Elevated ammonia levels can lead to neurological symptoms such as confusion, altered mental status, and even coma. Serum albumin, bilirubin, and prothrombin time are important in liver cirrhosis but are not the most concerning for acute neurological deterioration associated with hepatic encephalopathy.

5. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which laboratory value requires immediate intervention?

• A. Serum potassium of 6.5 mEq/L
• B. Serum sodium of 135 mEq/L
• C. Serum creatinine of 2.0 mg/dL
• D. Blood glucose of 150 mg/dL

Correct answer: A

Rationale: A serum potassium level of 6.5 mEq/L is most concerning in a client with CKD as it indicates severe hyperkalemia, requiring immediate intervention. Hyperkalemia can lead to life-threatening cardiac arrhythmias. Serum sodium levels within the normal range (135 mEq/L) are not immediately concerning. Serum creatinine of 2.0 mg/dL may indicate impaired kidney function but does not require immediate intervention for hyperkalemia. Blood glucose of 150 mg/dL is within normal limits and does not directly correlate with hyperkalemia in this scenario.

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