Nursing Elites

1. The healthcare professional assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory results should the healthcare professional review?

• A. Red blood cell count
• B. Platelet count
• C. Hemoglobin levels
• D. White blood cell count

Correct answer: B

Rationale: The platelet count is the most appropriate laboratory result to review in a client presenting with petechiae and ecchymosis. Petechiae and ecchymosis are indicative of potential bleeding issues, which can be caused by low platelet count or impaired platelet function. Platelets are essential for clotting, and a low platelet count can lead to bleeding disorders. Reviewing the platelet count will provide valuable information about the client's clotting ability. Choice A, red blood cell count, is not typically associated with petechiae and ecchymosis. Hemoglobin levels (Choice C) are more related to anemia than bleeding disorders like thrombocytopenia. White blood cell count (Choice D) is not directly linked to the presence of petechiae and ecchymosis, which are more specific to platelet-related issues.

2. Blood for arterial blood gas determinations is drawn from a client with pneumonia, and testing reveals a pH of 7.45, PCO2 of 30 mm Hg, and HCO3 of 19 mEq/L. The nurse interprets these results as indicative of:

• A. Compensated metabolic acidosis
• B. Compensated respiratory alkalosis
• C. Uncompensated metabolic alkalosis
• D. Uncompensated respiratory acidosis

Correct answer: B

Rationale: The correct answer is 'Compensated respiratory alkalosis.' In this case, the client's pH is within the normal range (7.35-7.45), indicating compensation. The low PCO2 (30 mm Hg) suggests respiratory alkalosis, while the low HCO3 (19 mEq/L) is also consistent with a compensatory response. Therefore, the client has a primary respiratory alkalosis that is being compensated for by metabolic acidosis. Choices A, C, and D are incorrect because they do not fit the pattern of the given blood gas values, which indicate respiratory alkalosis with metabolic compensation.

3. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding?

• A. Woman with a blood pressure of 158/90 mm Hg
• B. Client with Kussmaul respirations
• C. Man with skin itching from head to toe
• D. Client with halitosis and stomatitis

Correct answer: B

Rationale: The correct answer is B. Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The client is increasing the rate and depth of breathing to excrete carbon dioxide through the lungs, a compensatory mechanism for metabolic acidosis common in CKD. Hypertension, as in choice A, is a common finding in CKD due to volume overload and activation of the renin-angiotensin-aldosterone system. Skin itching, as in choice C, is related to calcium-phosphate imbalances seen in CKD. Halitosis and stomatitis, as in choice D, are common in CKD due to uremia, leading to the formation of ammonia. However, Kussmaul respirations indicate a more urgent need for assessment as they suggest impending respiratory distress and metabolic derangement, requiring immediate attention.

4. Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to:

• A. Control chest pain.
• B. Reduce coronary artery vasospasm.
• C. Control the arrhythmias associated with MI.
• D. Revascularize the blocked coronary artery.

Correct answer: D

Rationale: Alteplase recombinant, or t-PA, is a thrombolytic enzyme used to dissolve clots and revascularize the blocked coronary artery in patients experiencing a myocardial infarction (MI). Administering t-PA within the first 6 hours of MI onset is crucial to restore blood flow to the affected area and minimize cardiac tissue damage. Therefore, the correct answer is to revascularize the blocked coronary artery. Choices A, B, and C are incorrect because while controlling chest pain, reducing coronary artery vasospasm, and managing arrhythmias are important goals in managing MI, the primary purpose of administering t-PA within the first 6 hours is to restore blood flow by dissolving clots and revascularizing the blocked coronary artery.

5. A client who has just undergone surgery suddenly experiences chest pain, dyspnea, and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately sets about:

• A. Preparing the client for a perfusion scan
• B. Attaching the client to a cardiac monitor
• C. Administering oxygen via nasal cannula
• D. Ensuring that the intravenous (IV) line is patent

Correct answer: C

Rationale: When a client who has just undergone surgery experiences sudden chest pain, dyspnea, and tachypnea, indicating possible pulmonary embolism, the immediate priority for the nurse is to administer oxygen via nasal cannula. This intervention aims to improve oxygenation and alleviate respiratory distress, which is crucial in the setting of a potential pulmonary embolism. Preparing the client for a perfusion scan is not the immediate priority as stabilizing the client's respiratory status comes first. While attaching the client to a cardiac monitor is important for monitoring, administering oxygen takes precedence in this situation. Ensuring IV line patency is relevant for overall client care but is not the priority when a client is experiencing respiratory distress requiring immediate intervention.

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