Nursing Elites

1. A male client with impaired renal function who takes ibuprofen daily for chronic arthritis is admitted with gastrointestinal (GI) bleeding. After administering IV fluids and a blood transfusion, his blood pressure is 100/70, and his renal output is 20 ml/hour. Which intervention should the nurse include in care?

• A. Maintain the client NPO during the diuresis phase.
• B. Evaluate daily serial renal laboratory studies for progressive elevations.
• C. Observe the urine character for sedimentation and cloudy appearance.
• D. Monitor for onset of polyuria greater than 150ml/hour.

Correct answer: B

Rationale: Evaluating daily renal laboratory studies is crucial in this scenario. The client has impaired renal function, recent GI bleeding, and is at risk for further kidney damage due to ibuprofen use. Monitoring renal labs helps assess kidney function and detect any progressive elevations, guiding further interventions. Option A is not directly related to renal function monitoring. Option C focuses more on urine appearance than renal function assessment. Option D mentions polyuria, which is excessive urine output, but the question describes a client with reduced renal output.

2. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Elevate the head of the bed.
• C. Assess the client's level of consciousness.
• D. Obtain a sputum culture.

Correct answer: A

Rationale: Administering oxygen therapy as prescribed is the initial priority when managing an exacerbation of COPD. In COPD exacerbations, the primary concern is hypoxemia due to impaired gas exchange. Administering oxygen helps to improve oxygenation and prevent further complications. Elevating the head of the bed can aid in breathing comfort but is not the priority over ensuring adequate oxygen supply. Assessing the client's level of consciousness is important but comes after ensuring oxygenation. Obtaining a sputum culture is relevant for identifying pathogens but is not the immediate priority in addressing hypoxemia.

3. A client with cirrhosis is admitted with hepatic encephalopathy. Which clinical finding is most concerning?

• A. Confusion and altered mental status
• B. Increased abdominal girth
• C. Yellowing of the skin
• D. Peripheral edema

Correct answer: A

Rationale: Confusion and altered mental status are the most concerning clinical findings in a client with hepatic encephalopathy. These symptoms indicate worsening liver function and potential neurological complications, requiring immediate medical attention. Increased abdominal girth may suggest ascites, yellowing of the skin can indicate jaundice, and peripheral edema may be related to fluid retention, but in the context of hepatic encephalopathy, confusion and altered mental status take precedence due to the risk of rapid deterioration and the need for prompt management.

4. A client with rheumatoid arthritis is prescribed methotrexate. Which assessment finding requires immediate intervention?

• A. Fever of 100.4°F
• B. Positive Chvostek's sign
• C. Increased joint pain
• D. Swelling in the joints

Correct answer: B

Rationale: A positive Chvostek's sign indicates hypocalcemia, which requires immediate intervention as it can lead to life-threatening complications. Fever, increased joint pain, and swelling in the joints are common symptoms in clients with rheumatoid arthritis but do not require immediate intervention like addressing hypocalcemia.

5. An adult female client with chronic kidney disease (CKD) asks the nurse if she can continue taking over-the-counter medications. Which medication provides the greatest threat to this client?

• A. Magnesium hydroxide (Maalox).
• B. Birth control pills.
• C. Cough syrup containing codeine.
• D. Cold medication containing alcohol.

Correct answer: A

Rationale: The correct answer is A: Magnesium hydroxide (Maalox). In clients with CKD, magnesium can accumulate to toxic levels due to decreased excretion by the kidneys. Therefore, it poses the greatest threat to this client population. Choice B, birth control pills, is not typically contraindicated in CKD. Choice C, cough syrup containing codeine, may require dose adjustments but is not the greatest threat. Choice D, cold medication containing alcohol, is a concern mainly in liver disease, not CKD.

Similar Questions