Nursing Elites

1. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a “shift to the left” in the client’s white blood cell count. Which action should the nurse take?

• A. Request that the laboratory perform a differential analysis on the white blood cells.
• B. Notify the provider and start an intravenous line for parenteral antibiotics.
• C. Collaborate with the unlicensed assistive personnel (UAP) to strain the client’s urine for renal calculi.
• D. Assess the client for a potential allergic reaction and anaphylactic shock.

Correct answer: B

Rationale: A “shift to the left” in a white blood cell count indicates an increase in band cells, which is typically associated with urosepsis. In this scenario, the nurse should notify the provider and initiate IV antibiotics as a left shift is often seen in severe infections like urosepsis. Requesting a differential analysis on white blood cells would not be the immediate action needed in response to a left shift. Collaborating to strain urine for renal calculi is unrelated to the situation of a left shift in white blood cells due to urosepsis. Assessing for allergic reactions and anaphylactic shock is not the priority as a left shift is not indicative of an allergic response; it is associated with an increase in band cells, not eosinophils.

2. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?

• A. My sodium level changes due to the movement from the blood into the dialysate.
• B. Dialysis works by the movement of wastes from higher to lower concentration.
• C. Extra fluid can be pulled from the blood by osmosis.
• D. The dialysate is similar to blood but without any toxins.

Correct answer: B

Rationale: The correct answer is B because dialysis works by the movement of solutes from an area of higher concentration to an area of lower concentration, which is known as diffusion. The other statements are accurate: A correctly describes the movement of sodium during hemodialysis, C explains the removal of excess fluid by osmosis, and D highlights the purpose of the dialysate in removing toxins from the blood.

3. Which lab result would be most indicative of renal failure?

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

Correct answer: A

Rationale: The correct answer is A: Elevated creatinine levels. Creatinine is a waste product that is normally filtered by the kidneys. Elevated creatinine levels indicate impaired kidney function, which is commonly seen in renal failure. Choice B, low potassium levels, is not typically associated with renal failure. In fact, renal failure is more likely to cause high potassium levels due to the kidneys' inability to excrete potassium effectively. Choice C, low calcium levels, are not directly indicative of renal failure. Renal failure can lead to disturbances in calcium levels, but low calcium levels alone are not a specific marker for renal failure. Choice D, high sodium levels, are also not typically associated with renal failure. In renal failure, there may be disturbances in sodium levels, but high sodium levels alone are not a direct indicator of renal failure.

4. A client with a history of type 1 diabetes Mellitus (DM) and asthma is readmitted to the unit for the third time in two months with a current fasting blood sugar (FBS) of 325mg/dl (18mmol/L SI). The client describes to the nurse not understanding why the blood glucose level continues to be out of control. Which interventions should the nurse implement?

• A. Have the client describe a typical day at work, home, and social activities
• B. Determine if the client is using a new insulin needle for each administration
• C. Evaluate the client's asthma medications that can elevate blood glucose
• D. Have the client demonstrate the technique used to monitor blood glucose levels

Correct answer: A

Rationale: The correct answer is to have the client describe a typical day at work, home, and social activities. By understanding the client's daily routine, the nurse can gain valuable insights into lifestyle factors that may be impacting blood glucose control. This information is essential for identifying potential triggers or patterns contributing to the elevated blood sugar levels. Option B, determining if the client is using a new insulin needle for each administration, focuses more on the technical aspect of insulin delivery and is not directly related to daily activities affecting blood glucose levels. Option C, evaluating the client's asthma medications that can elevate blood glucose, could be relevant but is not as directly linked to the client's lifestyle choices as option A. Option D, having the client demonstrate the technique for monitoring blood glucose levels, is important for assessing their skills but does not provide information on daily activities that may be influencing blood sugar levels.

5. A client is being discharged after lithotripsy for a urinary calculus. Which statements should the nurse include in the discharge teaching? (Select all that apply.)

• A. Finish the prescribed antibiotic even if you are feeling better.
• B. Drink at least 3 liters of fluid each day.
• C. The bruising on your back may take several weeks to resolve.
• D. All of the above

Correct answer: D

Rationale: After lithotripsy for a urinary calculus, it is important for the client to complete the prescribed antibiotic course to prevent urinary tract infections. Drinking at least 3 liters of fluid daily helps dilute stone-forming crystals, prevent dehydration, and promote urine flow. Bruising on the back may occur after the procedure and can take several weeks to resolve. Additionally, the client may experience blood in the urine for several days post-procedure. Reporting any pain, fever, chills, or urination difficulties to the healthcare provider is essential, as these symptoms could indicate infection or stone formation. Choice D is correct as all the statements are appropriate for the client's discharge teaching. Choices A, B, and C are individually correct based on the rationale provided, making D the correct answer.

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