Nursing Elites

1. The nurse is assessing a client with chronic kidney disease (CKD). Which finding is most important for the nurse to respond to first?

• A. Potassium 6.0 mEq/L.
• B. Daily urine output of 400 ml.
• C. Peripheral neuropathy.
• D. Uremic fetor.

Correct answer: A

Rationale: The correct answer is A. Potassium level of 6.0 mEq/L indicates hyperkalemia, which is a critical electrolyte imbalance in clients with chronic kidney disease. Hyperkalemia can lead to life-threatening arrhythmias, making it the priority finding to address. Choice B, a daily urine output of 400 ml, may indicate decreased kidney function but does not pose an immediate life-threatening risk compared to hyperkalemia. Peripheral neuropathy (Choice C) and uremic fetor (Choice D) are common manifestations of CKD but are not as urgent as addressing a potentially fatal electrolyte imbalance like hyperkalemia.

2. During an interview with a client planning elective surgery, the client asks the nurse, 'What is the advantage of having a preferred provider organization insurance plan?' Which response is best for the nurse to provide?

• A. Neither plan allows the selection of healthcare providers or hospitals.
• B. There are fewer healthcare providers to choose from than in an HMO plan.
• C. An individual may select healthcare providers from outside of the PPO network.
• D. An individual can become a member of a PPO without belonging to a group.

Correct answer: C

Rationale: The best response for the nurse to provide is option C, as it highlights a key advantage of a preferred provider organization (PPO) insurance plan. By stating that an individual may select healthcare providers from outside of the PPO network, the nurse emphasizes the flexibility and freedom of choice that PPO plans offer. This feature allows individuals to seek care from providers who are not part of the PPO network, albeit at a higher cost. Option A is incorrect because both PPO and HMO plans allow the selection of healthcare providers, although with different restrictions. Option B is incorrect as PPO plans typically offer a larger selection of healthcare providers compared to HMO plans. Option D is incorrect as membership in a PPO usually requires affiliation with a group, such as through employment or membership in an organization.

3. The healthcare provider prescribes diagnostic tests for a client with pneumonia identified on a chest X-ray. Which diagnostic test should the nurse review for implementation to guide the most therapeutic treatment of pneumonia?

• A. Sputum culture and sensitivity
• B. Blood cultures
• C. Arterial blood gases (ABG)
• D. Computerized tomography (CT) of the chest

Correct answer: A

Rationale: Sputum culture and sensitivity is the most appropriate diagnostic test for pneumonia as it helps in identifying the causative organism, which is crucial for guiding the selection of the most effective antibiotic therapy. Blood cultures (choice B) are more useful in identifying systemic infections rather than pneumonia specifically. Arterial blood gases (ABG) (choice C) are helpful in assessing oxygenation but do not directly aid in identifying the causative organism. Computerized tomography (CT) of the chest (choice D) is useful for evaluating structural abnormalities in the lungs but is not the initial test of choice for diagnosing pneumonia.

4. A middle-aged adult with a family history of CAD has the following: total cholesterol 198 (11 mmol/L); LDL cholesterol 120 (6.7 mmol/L); HDL cholesterol 58 (3.2 mmol/L); triglycerides 148 (8.2 mmol/L); blood sugar 102 (5.7 mmol/L); and C-reactive protein (CRP) 4.2. The health care provider prescribes a statin medication and aspirin. The client asks the nurse why these medications are needed. Which is the best response by the nurse?

• A. The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a low-fat diet.
• B. The triglycerides are elevated and will not return to normal without these medications.
• C. The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications prescribed.
• D. These medications will reduce the risk of type 2 diabetes.

Correct answer: C

Rationale: CRP is a marker of inflammation, which is elevated in cardiovascular disease. Statins and aspirin help lower CRP and reduce the risk of heart attacks and strokes.

5. Which of the following lab values would be most concerning in a patient receiving heparin therapy?

• A. Elevated hemoglobin levels.
• B. Low platelet count.
• C. High potassium levels.
• D. Low sodium levels.

Correct answer: B

Rationale: A low platelet count is most concerning in patients receiving heparin therapy due to the risk of heparin-induced thrombocytopenia. Heparin can sometimes cause a drop in platelet count, leading to a potentially serious condition where blood does not clot as it should. This can result in excessive bleeding or clot formation in blood vessels. Elevated hemoglobin levels, high potassium levels, and low sodium levels are not typically associated with heparin therapy and are less likely to cause immediate concerns or complications in this context.

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