Nursing Elites

1. Prior to a percutaneous kidney biopsy, which actions should a nurse take? (Select all that apply.)

• A. Keep the client NPO for 4 to 6 hours.
• B. Obtain coagulation study results.
• C. Maintain strict bedrest in a supine position.
• D. A & B

Correct answer: D

Rationale: Prior to a percutaneous kidney biopsy, the nurse should ensure that the client is kept NPO for 4 to 6 hours to prevent aspiration during the procedure. Obtaining coagulation study results is crucial to assess the risk of bleeding during and after the biopsy. Strict bedrest in a supine position is not necessary before the procedure. It is important to note that blood pressure medications should be carefully managed, but it is not a pre-procedure action. Keeping the client on bedrest or assessing for blood in the urine are interventions that are more relevant post-procedure to monitor for complications.

2. A client with chronic kidney disease starts on hemodialysis. During the first dialysis treatment, the client's blood pressure drops from 150/90 to 80/30. Which action should the nurse take first?

• A. Stop the dialysis treatment
• B. Administer 5% albumin IV
• C. Monitor blood pressure every 45 minutes
• D. Lower the head of the chair and elevate feet

Correct answer: D

Rationale: The initial action the nurse should take when a client's blood pressure drops significantly during hemodialysis is to lower the head of the chair and elevate the feet. This position adjustment helps improve blood flow to the brain and vital organs, assisting in stabilizing blood pressure. Stopping the dialysis treatment immediately may not be necessary if the blood pressure can be managed effectively by position changes. Administering 5% albumin IV is not the first-line intervention for hypotension during dialysis. Monitoring blood pressure every 45 minutes is important but not the immediate action needed to address the significant drop in blood pressure observed during the dialysis session.

3. Which of the following lab results is most indicative of dehydration?

• A. Low sodium levels.
• B. Elevated creatinine levels.
• C. Low potassium levels.
• D. High blood glucose levels.

Correct answer: B

Rationale: Elevated creatinine levels are indicative of dehydration because when the body is dehydrated, the kidneys concentrate urine to preserve fluid, leading to higher levels of creatinine. Low sodium levels (Choice A) can be seen in conditions like hyponatremia but are not specific to dehydration. Low potassium levels (Choice C) are more commonly associated with conditions like hypokalemia. High blood glucose levels (Choice D) are typically seen in diabetes and are not specific indicators of dehydration.

4. In assessing cancer risk, which woman is at greatest risk of developing breast cancer?

• A. A 35-year-old multipara who never breastfed.
• B. A 50-year-old whose mother had unilateral breast cancer.
• C. A 55-year-old whose mother-in-law had bilateral breast cancer.
• D. A 20-year-old whose menarche occurred at age 9.

Correct answer: B

Rationale: The correct answer is B because family history of breast cancer, specifically in the mother, is a significant risk factor for developing breast cancer. The age of 50 is also a risk factor for breast cancer. Choice A is less likely as breastfeeding can actually reduce the risk of breast cancer. Choice C is less relevant since the risk is higher with a direct family member. Choice D, although early menarche is a risk factor, the age of the individual is much lower compared to the other age-related risk factors.

5. During nasotracheal suctioning, which of the following observations should be cause for concern to the nurse? Select all that apply.

• A. The client becomes cyanotic.
• B. Secretions are bloody.
• C. The client gags during the procedure.
• D. Clear to opaque secretions are removed.

Correct answer: C

Rationale: During nasotracheal suctioning, the client gagging during the procedure is a cause for concern as it can indicate discomfort or potential airway obstruction. Cyanosis, bloody secretions, or the removal of clear to opaque secretions are expected observations that the nurse should monitor for, but gagging indicates a need for immediate intervention to ensure the safety and comfort of the client. Cyanosis and bloody secretions can signify oxygenation issues and potential complications, while the removal of secretions is the goal of the suctioning procedure.

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