Nursing Elites

1. The nurse is caring for a client with chronic heart failure who is receiving furosemide (Lasix). Which laboratory value requires immediate intervention?

• A. Serum potassium of 3.0 mEq/L
• B. Serum sodium of 135 mEq/L
• C. Serum creatinine of 1.8 mg/dL
• D. Blood glucose of 200 mg/dL

Correct answer: A

Rationale: A serum potassium level of 3.0 mEq/L is most concerning in a client receiving furosemide as it indicates hypokalemia, which requires immediate intervention. Hypokalemia can lead to serious cardiac arrhythmias, which can be life-threatening. Serum sodium of 135 mEq/L and serum creatinine of 1.8 mg/dL are within normal ranges and do not require immediate intervention in this case. Blood glucose of 200 mg/dL is elevated but does not pose an immediate threat to the client's life in the context of heart failure and furosemide therapy.

2. The nurse is caring for a client who is postoperative following a thyroidectomy. Which laboratory value should be monitored closely?

• A. Serum calcium of 8.5 mg/dL
• B. Serum sodium of 136 mEq/L
• C. Serum potassium of 3.0 mEq/L
• D. Serum chloride of 102 mEq/L

Correct answer: C

Rationale: A serum potassium level of 3.0 mEq/L should be monitored closely in a client who is postoperative following a thyroidectomy to detect any electrolyte imbalances. After a thyroidectomy, there is a risk of hypokalemia due to the effects of anesthesia, stress response, and the surgical procedure itself. Monitoring serum potassium levels is crucial as hypokalemia can lead to cardiac arrhythmias and muscle weakness. Serum calcium, sodium, and chloride levels are important but not the primary focus following a thyroidectomy, making them incorrect choices.

3. A 65-year-old male client with a history of smoking and high cholesterol is admitted with shortness of breath and chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Pulmonary function tests (PFTs)

Correct answer: A

Rationale: The correct answer is an Electrocardiogram (ECG). An ECG should be performed first to assess for cardiac ischemia, especially given the client's symptoms and history. Chest X-ray (Choice B) may be ordered to evaluate the lungs but would not be the initial test for this client presenting with chest pain and shortness of breath. Arterial blood gases (ABGs) (Choice C) are used to assess oxygenation and acid-base balance but are not the primary diagnostic test for a client with suspected cardiac issues. Pulmonary function tests (PFTs) (Choice D) are used to assess lung function and would not be the first test indicated in this scenario.

4. The nurse is reinforcing home care instructions with a client who is being discharged following a transurethral resection of the prostate (TURP). Which intervention is most important for the nurse to include in the client's instructions?

• A. Avoid strenuous activity for 6 weeks.
• B. Report fresh blood in the urine.
• C. Take acetaminophen for fever of 101°F.
• D. Consume 6 to 8 glasses of water daily.

Correct answer: B

Rationale: Reporting fresh blood in the urine is crucial following a TURP procedure as it may indicate a complication such as bleeding or clot formation. This symptom requires immediate attention to prevent further complications. Choices A, C, and D are important aspects of post-TURP care, but identifying and reporting fresh blood in the urine take precedence due to its association with potential serious complications.

5. When planning care for a 10-year-old child with pneumonia receiving oxygen at 5l/min per nasal cannula, what principle of oxygen administration should the nurse consider?

• A. Avoid administration of oxygen at high levels for extended periods.
• B. Increase oxygen flow rate if the child is still tachypneic.
• C. Reduce oxygen levels gradually after symptoms improve.
• D. Humidify the oxygen to prevent drying of mucous membranes.

Correct answer: A

Rationale: The correct principle of oxygen administration to consider is to avoid administering oxygen at high levels for extended periods. High levels of oxygen for prolonged periods can lead to oxygen toxicity, especially in pediatric patients. Increasing the oxygen flow rate based on tachypnea may not be necessary and can potentially lead to oxygen toxicity. Gradually reducing oxygen levels after symptoms improve may compromise the child's oxygenation. While humidifying oxygen is important to prevent drying of mucous membranes, the primary concern in this case is to avoid high oxygen levels for an extended duration to prevent oxygen toxicity.

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