Nursing Elites

1. The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which clinical finding requires immediate intervention?

• A. Increased fatigue
• B. Elevated blood pressure
• C. Headache
• D. Elevated hemoglobin

Correct answer: A

Rationale: The correct answer is A, 'Increased fatigue.' In a client with CKD receiving erythropoietin therapy, increased fatigue can be a sign of polycythemia, a condition characterized by an elevated red blood cell count. This can lead to increased blood viscosity and raise the risk of thromboembolic events, necessitating immediate intervention. Elevated blood pressure (choice B) is a common concern in CKD but does not require immediate intervention in this context. Headache (choice C) may be related to elevated blood pressure but is not the most critical finding requiring immediate attention. Elevated hemoglobin (choice D) is an expected outcome of erythropoietin therapy and does not require immediate intervention unless excessively high.

2. A male client is prescribed clozapine (Clozaril), an antipsychotic medication, for the management of schizophrenia. Which client history should the nurse report to the healthcare provider before administering the first dose of this medication?

• A. History of depression
• B. History of cardiac arrhythmia
• C. History of seizures
• D. History of diabetes mellitus

Correct answer: B

Rationale: The correct answer is B: History of cardiac arrhythmia. Clozapine can lead to severe cardiovascular problems, making it crucial to report any history of cardiac arrhythmia to the healthcare provider before administering the medication. Choices A, C, and D are less concerning in this context as they are not directly associated with potential serious complications related to clozapine use.

3. The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value should the nurse monitor closely?

• A. Serum potassium level
• B. Hemoglobin level
• C. White blood cell count
• D. Serum calcium level

Correct answer: A

Rationale: In a client with chronic kidney disease (CKD) receiving erythropoietin therapy, the nurse should closely monitor the serum potassium level. Erythropoietin therapy can increase red blood cell production, leading to a higher demand for potassium. Monitoring potassium levels is crucial to prevent hyperkalemia, a potential risk associated with this therapy. Hemoglobin level (Choice B) is important to assess the effectiveness of erythropoietin therapy, but monitoring potassium levels takes precedence due to the risk of hyperkalemia. White blood cell count (Choice C) and serum calcium level (Choice D) are not directly affected by erythropoietin therapy in the context of chronic kidney disease.

4. The nurse is preparing to administer an IV dose of ciprofloxacin to a client with a urinary tract infection. Which client data requires the most immediate intervention by the nurse?

• A. Serum creatinine of 4.5 mg/dL (398 μmol/L SI)
• B. Temperature of 101.3°F
• C. Blood pressure of 140/90 mmHg
• D. Heart rate of 88 bpm

Correct answer: A

Rationale: A serum creatinine level of 4.5 mg/dL indicates severe renal impairment, which requires immediate attention before administering ciprofloxacin. Elevated serum creatinine levels suggest decreased kidney function, and giving ciprofloxacin can further harm the kidneys. Monitoring and addressing renal function are crucial to prevent worsening of renal impairment and potential drug toxicity. The temperature, blood pressure, and heart rate are important parameters to assess, but in this scenario, the priority is to address the severe renal impairment before proceeding with ciprofloxacin administration.

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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