Nursing Elites

1. A male client is admitted with a bowel obstruction and intractable vomiting for the last several hours despite the use of antiemetics. Which intervention should the nurse implement first?

• A. Infuse 0.9% sodium chloride 500 ml bolus
• B. Administer an antiemetic intravenously
• C. Insert a nasogastric tube
• D. Prepare the client for surgery

Correct answer: A

Rationale: The correct first intervention for a male client with a bowel obstruction and intractable vomiting is to infuse 0.9% sodium chloride 500 ml bolus. This intervention is crucial to address the risk of hypovolemia due to excessive vomiting. Administering intravenous fluids will help prevent dehydration, maintain blood pressure, and stabilize the client's condition. Choice B, administering an antiemetic intravenously, may not be effective as the client has already been unresponsive to antiemetics orally. Choice C, inserting a nasogastric tube, may be necessary but is not the priority in this situation. Choice D, preparing the client for surgery, should only be considered after stabilizing the client's fluid and electrolyte balance.

2. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which laboratory value should the nurse report to the healthcare provider immediately?

• A. Serum potassium of 5.5 mEq/L
• B. Serum calcium of 8 mg/dL
• C. Serum creatinine of 2.0 mg/dL
• D. White blood cell count of 10,000/mm³

Correct answer: A

Rationale: A serum potassium level of 5.5 mEq/L is concerning in a client with ESRD scheduled for hemodialysis as it indicates hyperkalemia, requiring immediate intervention. Hyperkalemia can lead to serious cardiac arrhythmias, especially during hemodialysis. Serum calcium, serum creatinine, and white blood cell count, while important, do not pose immediate life-threatening risks like hyperkalemia.

3. A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?

• A. Serum creatinine of 1.8 mg/dl
• B. Prothrombin time of 18 seconds
• C. Hemoglobin of 9 g/dl
• D. Platelet count of 90,000/mm3

Correct answer: D

Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.

4. A client with a history of chronic heart failure is admitted with shortness of breath and crackles in the lungs. Which laboratory value should be closely monitored?

• A. Serum creatinine of 2.0 mg/dL
• B. Serum sodium of 135 mEq/L
• C. Serum potassium of 5.5 mEq/L
• D. Blood glucose of 150 mg/dL

Correct answer: C

Rationale: A serum potassium level of 5.5 mEq/L should be closely monitored in a client with chronic heart failure as it may indicate hyperkalemia, requiring intervention. Hyperkalemia can lead to life-threatening cardiac arrhythmias in patients with heart failure. Serum creatinine (Choice A) is important to monitor for kidney function but is not the priority in this case. Serum sodium (Choice B) and blood glucose (Choice D) levels are not typically the primary focus when assessing a client with heart failure presenting with respiratory symptoms and crackles in the lungs.

5. A client who had a gestational trophoblastic disease (GTD) evacuated 2 days ago is being monitored for choriocarcinoma. She lives in a rural area, and her husband takes the family car to work daily, leaving her without transportation during the day. What intervention is most important for the nurse to implement?

• A. Teach the client about the use of a home pregnancy test.
• B. Schedule a weekly home visit to draw hCG values.
• C. Make a 5-week follow-up appointment with the healthcare provider.
• D. Begin chemotherapy administration during the first home visit.

Correct answer: B

Rationale: Scheduling weekly home visits to monitor hCG levels is critical for early detection of choriocarcinoma, a potential complication of GTD. Choice A is incorrect because a home pregnancy test is not the appropriate method to monitor for choriocarcinoma. Choice C is less frequent than necessary for close monitoring. Choice D is incorrect as chemotherapy administration should be based on confirmed diagnosis and treatment plan, not initiated during the first home visit.

Similar Questions