Nursing Elites

1. A client has an elevated blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?

• A. Assess the client’s dietary habits.
• B. Inquire about the client's use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• C. Hold the client’s metformin (Glucophage).
• D. Contact the health care provider immediately.

Correct answer: A

Rationale: An elevated blood urea nitrogen (BUN)/creatinine ratio can indicate various conditions such as dehydration, urinary obstruction, catabolism, or a high-protein diet. The initial action the nurse should take is to assess the client’s dietary habits to determine if the elevated ratio is related to diet. Inquiring about the use of NSAIDs is important as they can impact kidney function, but dietary causes should be ruled out first. Holding metformin or contacting the health care provider without assessing the dietary habits would be premature actions as they may not address the underlying cause of the elevated BUN/creatinine ratio.

2. The healthcare provider is unable to palpate the client's left pedal pulses. Which of the following actions should the healthcare provider take next?

• A. Auscultate the pulses with a stethoscope.
• B. Call the physician.
• C. Use a Doppler ultrasound device.
• D. Inspect the lower left extremity.

Correct answer: C

Rationale: When pedal pulses are not palpable, using a Doppler ultrasound device is the appropriate next step to locate the pulse. Auscultating the pulses with a stethoscope (Choice A) is used for assessing blood flow in arteries above the clavicle, not for pedal pulses. Calling the physician (Choice B) may be necessary at a later stage, but initially, using a Doppler ultrasound device to locate the pulse is more appropriate. Inspecting the lower left extremity (Choice D) can provide visual information but will not help in locating the pedal pulses, making it a less suitable option.

3. A client has the following arterial blood gas (ABG) results: pH 7.51, PCO2 31 mm Hg, PO2 94 mm Hg, HCO3 24 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: D

Rationale: The ABG results show a pH above the normal range (7.35-7.45) and a decreased PCO2, indicating respiratory alkalosis. In respiratory alkalosis, the pH is increased and the PCO2 is decreased. Metabolic acidosis (choice A) would present with a low pH and low HCO3 levels. Metabolic alkalosis (choice B) would show an increased pH and HCO3 levels. Respiratory acidosis (choice C) would have a low pH and an increased PCO2.

4. The healthcare provider is assessing a client undergoing peritoneal dialysis. Which of the following findings should be reported immediately to the physician?

• A. Clear dialysate outflow.
• B. Clear dialysate inflow.
• C. Cloudy dialysate outflow.
• D. Increased blood pressure.

Correct answer: C

Rationale: Cloudy dialysate outflow should be reported immediately to the physician as it is a concerning sign of peritonitis, a severe infection of the peritoneum. Peritonitis is a serious complication of peritoneal dialysis that requires prompt medical intervention to prevent further complications. Clear dialysate outflow and inflow are normal findings in peritoneal dialysis and do not indicate an immediate need for intervention. Increased blood pressure, while important to monitor, is not directly related to peritoneal dialysis and would not be the priority over the potentially life-threatening complication of peritonitis.

5. Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma?

• A. Numbness, tingling, and cramps in the extremities.
• B. Headache, diaphoresis, and palpitations.
• C. Cyanosis, fever, and classic signs of shock.
• D. Nausea, vomiting, and muscular weakness.

Correct answer: B

Rationale: Correct. Pheochromocytoma is a catecholamine-secreting non-cancerous tumor of the adrenal medulla. The classic triad of symptoms includes headache, diaphoresis (excessive sweating), and palpitations, which result from the overproduction of catecholamines like epinephrine and norepinephrine. Numbness, tingling, and cramps in the extremities (Option A) are not characteristic of pheochromocytoma. Cyanosis, fever, and classic signs of shock (Option C) are not typical symptoms of this condition. Nausea, vomiting, and muscular weakness (Option D) are not commonly associated with pheochromocytoma.

Similar Questions