Nursing Elites

1. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?

• A. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.
• B. Continue the intravenous fluids as ordered and reassess the patient frequently.
• C. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.
• D. Stop the intravenous fluids and notify the provider of the assessment findings.

Correct answer: D

Rationale: The patient’s potassium level is within normal limits, but the decreased urine output indicates the patient should not receive additional IV potassium. Increasing potassium chloride to 40 mEq/L is not needed as the level is normal. Stopping the IV fluids is appropriate due to the decreased urine output, which suggests potential fluid overload. The nurse should notify the provider of the assessment findings for further management. Increasing the rate of fluids to 200 mL/hour is not recommended without addressing the decreased urine output first.

2. A client with a family history of polycystic kidney disease (PKD is being assessed by a nurse. For which clinical manifestations should the nurse assess? (Select all that apply.)

• A. Nocturia
• B. Flank pain
• C. Increased abdominal girth
• D. B & C

Correct answer: D

Rationale: Clients with PKD commonly present with flank pain and increased abdominal girth due to abdominal distention caused by cysts. Bloody urine is also a common symptom due to tissue damage from PKD. Nocturia and dysuria are not typical manifestations of PKD. Constipation is not directly associated with PKD. Therefore, the correct choices are flank pain and increased abdominal girth, making option D the correct answer.

3. The healthcare provider is assessing an older Caucasian male who has a history of peripheral vascular disease. The healthcare provider observes that the man's left great toe is black. The discoloration is probably a result of:

• A. Atrophy.
• B. Contraction.
• C. Gangrene.
• D. Rubor.

Correct answer: C

Rationale: Gangrene refers to dead, blackened tissue, often a result of chronic ischemia in clients with peripheral vascular disease. Atrophy (Choice A) is the wasting away or decrease in size of tissue or organ. Contraction (Choice B) refers to the shortening or tightening of a muscle or other body part. Rubor (Choice D) is a red discoloration of the skin, often associated with inflammation or poor circulation, but not typically presenting as blackening like gangrene.

4. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

5. A nurse contacts the healthcare provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?

• A. Intravenous fluids
• B. Hemodialysis
• C. Fluid restriction
• D. Urine culture and sensitivity

Correct answer: A

Rationale: The normal range for BUN is 10 to 20 mg/dL, and for creatinine, it is 0.6 to 1.2 mg/dL in males and 0.5 to 1.1 mg/dL in females. Creatinine is a more specific marker for kidney function compared to BUN. In this case, the client's creatinine level is within the normal range, indicating a non-renal cause for the elevated BUN. Dehydration is a common cause of increased BUN, so the appropriate action would be to recommend intravenous fluids to address the dehydration. Fluid restriction is not indicated as the client needs hydration. Hemodialysis is not appropriate for dehydration and is typically reserved for renal failure. The laboratory results do not suggest an infection, making a urine culture and sensitivity unnecessary in this scenario.

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