Nursing Elites

1. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

• A. Registered nurse who just floated from the surgical unit
• B. Registered nurse who just floated from the dialysis unit
• C. Registered nurse who was assigned the same client yesterday
• D. Licensed practical nurse with 5 years of experience on this floor

Correct answer: C

Rationale: The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is crucial to assess subtle changes in clients' conditions. Therefore, the registered nurse (RN) who previously cared for this client should be assigned again. Float nurses may lack knowledge of the unit and its clients, potentially leading to oversight of critical details. The licensed practical nurse, while experienced, may not possess the advanced assessment skills and education level of an RN to effectively evaluate and manage pericarditis in this client.

2. The client with chronic renal failure is receiving education on managing fluid intake. Which of the following statements by the client indicates a need for further teaching?

• A. I can drink as much water as I want.
• B. I should increase my intake of high-sodium foods.
• C. I can skip a dialysis session if I feel tired.
• D. I can eat whatever I want as long as I take my medications.

Correct answer: C

Rationale: Choice C is the correct answer. Clients with chronic renal failure should not skip dialysis sessions, as this can lead to serious complications. Dialysis is crucial for managing fluid and electrolyte balance in these clients. Choice A is incorrect because clients with renal failure often have fluid restrictions. Choice B is incorrect as high-sodium foods can worsen fluid retention in clients with renal failure. Choice D is incorrect because dietary restrictions are important in managing chronic renal failure, and eating whatever one wants can lead to further complications.

3. After educating a client with a history of renal calculi, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I should drink at least 3 liters of fluid every day.
• B. I will eliminate all dairy or sources of calcium from my diet.
• C. Aspirin and aspirin-containing products can lead to stones.
• D. The doctor can give me antibiotics at the first sign of a stone.

Correct answer: A

Rationale: To prevent the formation of renal calculi, it is essential to maintain adequate hydration as dehydration can contribute to the precipitation of minerals leading to stone formation. Therefore, the correct statement indicating understanding of the teaching is choice A. Increasing fluid intake helps dilute urine and reduces the risk of stone formation. Eliminating all sources of calcium is not recommended as calcium is essential for various bodily functions and eliminating it can lead to other health issues. Aspirin and aspirin-containing products do not directly cause kidney stones. Antibiotics are not used to prevent or treat renal calculi, as they are not caused by bacterial infections.

4. A healthcare professional is reviewing the results of serum laboratory studies of a client with suspected hepatitis. Which increased parameter is interpreted as the most specific indicator of this disease?

• A. Hemoglobin
• B. Serum bilirubin
• C. Blood urea nitrogen (BUN)
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Serum bilirubin is the most specific indicator of hepatitis as it reflects liver dysfunction. Hemoglobin, blood urea nitrogen (BUN), and erythrocyte sedimentation rate (ESR) are not specific to hepatitis. Hemoglobin measures the oxygen-carrying capacity of red blood cells, BUN evaluates kidney function, and ESR is a nonspecific marker of inflammation or infection.

5. A marathon runner comes into the clinic and states, 'I have not urinated very much in the last few days.' The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?

• A. Give the client a bottle of water immediately.
• B. Start an intravenous line for fluids.
• C. Teach the client to drink 2 to 3 liters of water daily.
• D. Perform an electrocardiogram.

Correct answer: A

Rationale: The priority action for the nurse is to give the client a bottle of water immediately. The athlete's symptoms of decreased urination, along with a heart rate of 110 beats/min and low blood pressure of 86/58 mm Hg, indicate mild dehydration. Rehydration should begin promptly to address the dehydration. Teaching the client to drink 2 to 3 liters of water daily is a good long-term strategy but not the immediate priority. Starting an intravenous line for fluids may be necessary if oral hydration is insufficient or if the degree of dehydration is severe. Performing an electrocardiogram is not indicated at this time as the priority is addressing the dehydration.

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