Nursing Elites

1. An adult female client with chronic kidney disease (CKD) asks the nurse if she can continue taking her over-the-counter medications. Which medication poses the greatest threat to this client?

• A. Magnesium hydroxide (Maalox).
• B. Birth control pills.
• C. Cough syrup containing codeine.
• D. Cold medication containing alcohol.

Correct answer: A

Rationale: The correct answer is A, Magnesium hydroxide (Maalox). In clients with chronic kidney disease (CKD), magnesium can accumulate to toxic levels as the kidneys are unable to excrete it efficiently. This can lead to hypermagnesemia, causing serious and potentially life-threatening complications. Birth control pills (choice B) are metabolized mainly by the liver and do not pose a significant threat to clients with CKD. Cough syrup containing codeine (choice C) should be used cautiously in CKD due to the risk of respiratory depression but does not pose as great a threat as magnesium accumulation. Cold medication containing alcohol (choice D) should be avoided in CKD but does not present the same level of danger as magnesium toxicity.

2. The nurse is assessing a client with left-sided heart failure. Which finding should be reported to the healthcare provider immediately?

• A. Shortness of breath
• B. Jugular venous distention
• C. Crackles in the lungs
• D. Elevated liver enzymes

Correct answer: C

Rationale: In a client with left-sided heart failure, the presence of crackles in the lungs is the most critical finding that should be reported to the healthcare provider immediately. Crackles indicate pulmonary congestion, which requires prompt intervention to prevent respiratory compromise. Shortness of breath, though a common symptom in heart failure, is a result of pulmonary congestion, making crackles a more direct indicator of the severity of the condition. Jugular venous distention and elevated liver enzymes are important to assess in heart failure but are not as immediately concerning as crackles in the lungs, which directly reflect the impact of heart failure on the respiratory system.

3. A client with type 2 diabetes is admitted with hyperglycemic hyperosmolar syndrome (HHS). Which clinical finding is most concerning to the nurse?

• A. Serum glucose of 500 mg/dL
• B. Blood pressure of 140/90 mmHg
• C. Serum osmolarity of 320 mOsm/kg
• D. Serum pH of 7.30

Correct answer: C

Rationale: A serum osmolarity of 320 mOsm/kg is the most concerning finding in a client with hyperglycemic hyperosmolar syndrome (HHS) as it indicates severe dehydration and hypertonicity. This high serum osmolarity level can lead to neurological complications and requires immediate intervention to prevent further deterioration. Serum glucose levels, blood pressure, and serum pH are important parameters to monitor in HHS, but a significantly elevated serum osmolarity poses a higher risk of complications and warrants urgent attention. High serum glucose levels, like 500 mg/dL, are expected in HHS but do not directly indicate the severity of dehydration. Blood pressure of 140/90 mmHg is within normal limits and may not be directly related to the acute complications of HHS. A serum pH of 7.30 suggests acidosis, which is important to address but may not be as immediately concerning as severe dehydration indicated by high serum osmolarity.

4. A client with end-stage renal disease (ESRD is scheduled for hemodialysis. Which laboratory value should the nurse monitor closely before the procedure?

• A. Serum creatinine
• B. Serum potassium
• C. Serum sodium
• D. Hemoglobin

Correct answer: B

Rationale: Before hemodialysis in a client with end-stage renal disease (ESRD), monitoring serum potassium closely is crucial. ESRD patients are at risk of hyperkalemia, which can lead to severe cardiac complications. Checking serum potassium levels helps in assessing and managing this electrolyte imbalance. Serum creatinine (Choice A) is a marker of kidney function but is not the most critical value to monitor before hemodialysis. Serum sodium (Choice C) may be affected in renal disease, but potassium is a more crucial electrolyte to monitor. Hemoglobin (Choice D) is essential for assessing anemia in ESRD but is not the primary focus before hemodialysis.

5. The nurse who is working on a surgical unit receives a change of shift report on a group of clients for the upcoming shift. A client with which condition requires the most immediate attention by the nurse?

• A. Gunshot wound three hours ago with dark drainage of 2 cm noted on the dressing.
• B. Mastectomy 2 days ago with 50 ml bloody drainage noted in the Jackson-Pratt drain.
• C. Collapsed lung after a fall 8 hours ago with 100 ml blood in the chest tube collection container
• D. Abdominal-perineal resection 2 days ago with no drainage on dressing who has fever and chills.

Correct answer: D

Rationale: The correct answer is D. A client who had an abdominal-perineal resection 2 days ago with no drainage on the dressing but is presenting with fever and chills requires immediate attention. This presentation raises concerns for peritonitis, a serious complication that necessitates prompt assessment and intervention to prevent further complications. Choices A, B, and C do not indicate an immediate risk for a life-threatening condition like peritonitis, making them lower priority compared to choice D.

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