Nursing Elites

1. A healthcare professional reviews the blood gas results of a client in respiratory distress. The pH is 7.32, and the PCO2 is 50 mm Hg. Which of the following acid-base imbalances does the professional recognize in these findings?

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

Correct answer: C

Rationale: In respiratory acidosis, the pH is low (<7.35) and the PCO2 is increased (>45 mm Hg). These findings indicate that the client is experiencing respiratory acidosis, a condition where there is an excess of carbon dioxide in the blood due to inadequate ventilation, commonly seen in respiratory distress. Metabolic acidosis (Choice A) is characterized by a low pH and decreased bicarbonate levels, which is not the case in this scenario. Metabolic alkalosis (Choice B) is associated with a high pH and increased bicarbonate levels. Respiratory alkalosis (Choice D) is marked by a high pH and decreased PCO2, opposite to the values presented in the blood gas results of this client.

2. Which client is at greatest risk for coronary artery disease?

• A. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
• B. A 43-year-old male with a family history of CAD and a cholesterol level of 158 (8.8 mmol/L).
• C. A 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin.
• D. A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L).

Correct answer: D

Rationale: The 65-year-old female who is obese with a high LDL level of 188 (10.4 mmol/L) is at the greatest risk for coronary artery disease. Obesity and high LDL cholesterol levels are significant risk factors for developing coronary artery disease. While factors like mitral valve prolapse (choice A) and a family history of CAD (choice B) can contribute to the risk, they are not as significant as obesity and high LDL levels. Choice C, a 56-year-old male with high HDL and taking atorvastatin, is actually at lower risk due to the high HDL levels and being on statin therapy, which helps reduce cholesterol levels and lower the risk of coronary artery disease.

3. A nurse is assessing a postoperative client on an hourly basis. The nurse notes that the client’s urine output for the past hour was 25 mL. Based on this finding, the nurse first:

• A. Calls the physician
• B. Increases the rate of the IV infusion
• C. Checks the client’s overall intake and output record
• D. Administers a 250-mL bolus of normal saline solution (0.9%)

Correct answer: C

Rationale: Clients are at risk of hypovolemia postoperatively, and decreased urine output can be an early sign. However, to accurately interpret this finding, the nurse must assess the overall fluid balance by checking the client’s intake and output records. Increasing the IV infusion rate or administering a bolus of normal saline solution without a physician's order would not be appropriate as these interventions require a prescription. The physician should be notified once the nurse has collected all necessary assessment data, including fluid status and vital signs.

4. The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?

• A. Administer the medication and give the infant extra oral fluids.
• B. Contact the provider to request adding intravenous fluids when giving the medication.
• C. Give the medication and obtain a serum peak drug level 45 minutes after the dose.
• D. Hold the dose and contact the provider to request a serum trough drug level.

Correct answer: D

Rationale: In this scenario, the infant not having a wet diaper for several hours indicates a potential decrease in urine output, which can be a sign of nephrotoxicity related to gentamicin. The correct action for the nurse is to hold the dose and contact the provider to request a serum trough drug level. This is important to monitor the drug levels and ensure that they are not reaching toxic levels. Administering the medication without addressing the decreased urine output could potentially lead to further nephrotoxicity. Contacting the provider to add intravenous fluids or obtaining a serum peak drug level are not the most appropriate actions in this situation as the priority is to assess for potential nephrotoxicity and ensure patient safety.

5. The nurse is caring for a client with chronic renal failure who is on a low-potassium diet. Which of the following foods should the client avoid?

• A. Bananas
• B. Potatoes
• C. Rice
• D. Apples

Correct answer: A

Rationale: Bananas are high in potassium content, which can lead to hyperkalemia in clients with chronic renal failure who are on a low-potassium diet. Therefore, it is crucial for these clients to avoid bananas. Potatoes, rice, and apples are lower in potassium compared to bananas and are generally considered safe for consumption in clients with chronic renal failure on a low-potassium diet.

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