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. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client’s care?

• A. Edema and pain
• B. Electrolyte and fluid imbalance
• C. Cardiac and respiratory status
• D. Mental health status

Correct answer: B

Rationale: The major concern for a client admitted with acute kidney injury (AKI) and a high urine output of 2000 mL/day is electrolyte and fluid imbalance. In AKI, there may be an inflammatory cause leading to proteins entering the glomerulus, resulting in fluid being held in the filtrate and causing polyuria. Electrolyte loss and fluid balance are critical to monitor and manage in AKI cases. Edema and pain are not typically associated with fluid loss. While changes in cardiac, respiratory, and mental health status can occur if electrolyte imbalance is not addressed, the primary focus should be on managing electrolyte and fluid balance to prevent further complications.

3. A nurse performing nasopharyngeal suctioning suddenly notes the presence of bloody secretions. What should the nurse do first?

• A. Continue suctioning to remove the blood
• B. Check the degree of suction being applied
• C. Encourage the client to cough out the bloody secretions
• D. Remove the suction catheter from the client’s nose and begin vigorous suctioning through the mouth

Correct answer: B

Rationale: The correct answer is to check the degree of suction being applied (Choice B). When bloody secretions are encountered during nasopharyngeal suctioning, it is crucial to assess the situation promptly. Checking the degree of suction being applied is the first step as excessive suction pressure may be causing trauma and bleeding. Adjusting the suction pressure may be necessary to prevent further harm. Continuing suctioning to remove the blood (Choice A) or performing vigorous suctioning through the mouth (Choice D) can lead to increased trauma and worsen bleeding. Encouraging the client to cough out the bloody secretions (Choice C) is not appropriate since the client undergoing suctioning is typically unable to expectorate secretions. Therefore, the priority is to check and adjust the suction settings to ensure safe and effective suctioning.

4. The client with chronic renal failure is being educated on dietary restrictions. Which of the following foods should the client avoid?

• A. Bananas.
• B. Oranges.
• C. Rice.
• D. Apples.

Correct answer: A

Rationale: The correct answer is A: Bananas. Bananas are high in potassium, and clients with chronic renal failure are often advised to follow a low-potassium diet to prevent hyperkalemia. Oranges and apples are also high in potassium and should be avoided by clients with renal issues. Rice, on the other hand, is low in potassium and is generally considered safe for individuals with chronic renal failure to consume in moderation.

5. The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is:

• A. Decreased blood flow.
• B. Increased blood flow.
• C. Slow blood flow.
• D. Thrombus formation.

Correct answer: A

Rationale: The correct answer is A: 'Decreased blood flow.' In peripheral vascular disease (PVD), there is a narrowing or blockage of blood vessels, leading to reduced blood flow to the extremities. This decreased blood flow results in inadequate oxygen supply to the muscles, causing pain, especially during physical activity when oxygen demand increases. Choice B, 'Increased blood flow,' is incorrect because PVD is characterized by impaired blood circulation rather than increased flow. Choice C, 'Slow blood flow,' is not precise as PVD involves a more significant reduction in blood flow. Choice D, 'Thrombus formation,' is related to the formation of blood clots within vessels, which can be a complication of PVD but is not its main characteristic.

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