Nursing Elites

1. The nurse is assessing a client with chronic heart failure who is receiving furosemide (Lasix). Which assessment finding is most concerning?

• A. Heart rate of 60 beats per minute
• B. Blood pressure of 110/70 mmHg
• C. Elevated liver enzymes
• D. Elevated blood glucose level

Correct answer: C

Rationale: Elevated liver enzymes are most concerning in a client with chronic heart failure as they may indicate liver congestion or worsening heart failure, requiring immediate intervention. Elevated liver enzymes can be a sign of hepatotoxicity or liver damage, which could be a result of furosemide (Lasix) use. Monitoring liver function is crucial in patients taking furosemide due to the risk of hepatotoxicity. A heart rate of 60 beats per minute and a blood pressure of 110/70 mmHg are within normal ranges for a client with chronic heart failure. An elevated blood glucose level may be expected due to the effects of furosemide but is not as immediately concerning as elevated liver enzymes.

2. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which assessment finding should be reported to the healthcare provider immediately?

• A. Blood pressure of 110/70 mmHg
• B. Heart rate of 80 beats per minute
• C. Fever of 100.4°F
• D. Respiratory rate of 24 breaths per minute

Correct answer: C

Rationale: The correct answer is C. A fever of 100.4°F is most concerning in a client with ESRD scheduled for hemodialysis as it may indicate an underlying infection, which can lead to serious complications in this population. Elevated body temperature can be a sign of sepsis, which requires immediate attention to prevent further deterioration. Reporting this finding promptly allows for timely intervention. Choices A, B, and D are within normal ranges and do not pose an immediate threat to the client's well-being in the context of preparing for hemodialysis.

3. A 12-year-old boy has a body mass index (BMI) of 28, a systolic pressure, and a glycosylated hemoglobin (HBA1C) of 7.8%. Which selection indicates that his mother understands the management of his diet?

• A. One whole-wheat bagel with cream cheese, two strips of bacon, six ounces of orange juice.
• B. Two eggs with toast and butter, 8 ounces of milk.
• C. Fresh fruit salad with low-fat yogurt.
• D. Pancakes with syrup and sausage links.

Correct answer: C

Rationale: The correct answer is C. Fresh fruit salad with low-fat yogurt is a healthier choice for managing the diet of a 12-year-old boy with a high BMI and elevated HBA1C. This choice provides a good balance of nutrients, fiber, and low-fat content, helping to lower BMI and maintain healthy blood sugar levels. Choices A, B, and D are less ideal as they contain higher levels of refined carbohydrates, saturated fats, and sugars, which can contribute to weight gain and worsen blood sugar control in this scenario.

4. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which intervention should the nurse implement first?

• A. Administer intravenous insulin as prescribed.
• B. Monitor the client's urine output.
• C. Administer intravenous fluids.
• D. Administer 50% dextrose IV push.

Correct answer: A

Rationale: Administering intravenous insulin is the initial priority in managing diabetic ketoacidosis (DKA). Insulin helps to reduce blood glucose levels and correct metabolic acidosis, addressing the underlying cause of DKA. Monitoring urine output (choice B) is important but is not the first intervention needed. Administering intravenous fluids (choice C) is essential to correct dehydration in DKA, but insulin therapy takes precedence. Administering 50% dextrose IV push (choice D) is contraindicated in DKA as it can exacerbate hyperglycemia.

5. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value is most concerning?

• A. Serum potassium of 5.5 mEq/L
• B. Serum creatinine of 1.5 mg/dl
• C. Serum creatinine of 2.5 mg/dl
• D. White blood cell count of 8,000/mm3

Correct answer: C

Rationale: A serum creatinine level of 2.5 mg/dl is the most concerning laboratory value in a client with chronic kidney disease scheduled for a renal biopsy. An elevated serum creatinine level indicates impaired kidney function, which is critical information before performing a renal biopsy. Option A (Serum potassium of 5.5 mEq/L) may be concerning for hyperkalemia but is not directly related to the renal biopsy procedure. Option B (Serum creatinine of 1.5 mg/dl) is within normal limits, suggesting relatively normal kidney function. Option D (White blood cell count of 8,000/mm3) is within the normal range and not directly related to the renal biopsy procedure or CKD management.

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