Nursing Elites

1. The nurse is caring for a client with chronic kidney disease (CKD). Which laboratory value should be reported to the healthcare provider immediately?

• A. Serum creatinine of 2.0 mg/dl
• B. Hemoglobin of 10 g/dl
• C. Potassium of 6.5 mEq/L
• D. Blood glucose of 150 mg/dl

Correct answer: C

Rationale: The correct answer is C. A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, and requires immediate intervention to prevent cardiac complications. Hyperkalemia can lead to life-threatening arrhythmias, making it crucial to notify the healthcare provider promptly. Choices A, B, and D do not indicate immediate life-threatening conditions. Elevated serum creatinine levels are expected in CKD, a hemoglobin level of 10 g/dl is within a reasonable range, and a blood glucose level of 150 mg/dl is not acutely concerning in this context.

2. After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart sounds. To determine if an S3 heart sound is present, what action should the nurse take first?

• A. Slide the stethoscope across the sternum.
• B. Move the stethoscope to the mitral site.
• C. Listen with the bell at the same location.
• D. Observe the cardiac telemetry monitor.

Correct answer: C

Rationale: The nurse uses the bell of the stethoscope to hear low-pitched sounds such as S3 and S4. To determine if an S3 heart sound is present, the nurse should listen at the same location using the bell first. This allows for the accurate identification of low-pitched sounds. Moving the stethoscope across the sternum (Choice A) or to the mitral site (Choice B) would not be the initial actions to assess for an S3 heart sound. Observing the cardiac telemetry monitor (Choice D) is not relevant for assessing S3 heart sounds, as it does not provide direct auscultation of heart sounds.

3. The client with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen. Which laboratory value is most concerning?

• A. Serum sodium of 135 mEq/L
• B. Serum potassium of 4.0 mEq/L
• C. Serum bicarbonate of 18 mEq/L
• D. Serum glucose of 300 mg/dl

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L is concerning in a client with COPD receiving supplemental oxygen as it indicates metabolic acidosis, which can occur due to the body compensating for chronic respiratory acidosis. This condition requires immediate intervention to restore the acid-base balance. Choice A, serum sodium of 135 mEq/L, is within normal range (135-145 mEq/L) and not directly related to COPD or oxygen therapy. Choice B, serum potassium of 4.0 mEq/L, falls within the normal range (3.5-5.0 mEq/L) and is not typically affected by COPD or oxygen therapy. Choice D, serum glucose of 300 mg/dl, though elevated, is not directly related to COPD or oxygen therapy and would require management but is not the most concerning value in this scenario.

4. The unit clerk reports to the charge nurse that a healthcare provider has written several prescriptions that are illegible and it appears the healthcare provider used several unapproved abbreviations in the prescriptions. What actions should the charge nurse take?

• A. Call the healthcare provider who wrote the prescription
• B. Attempt to clarify the prescriptions with the pharmacist
• C. Administer the medications as prescribed
• D. Ask another healthcare provider for clarification

Correct answer: A

Rationale: The correct action for the charge nurse to take is to call the healthcare provider who wrote the illegible prescriptions. It is crucial to clarify illegible prescriptions directly with the provider to ensure patient safety and prevent medication errors. Option B, attempting to clarify with the pharmacist, may lead to misinterpretation and is not the recommended first step. Administering the medications as prescribed without clarity can jeopardize patient safety, making option C incorrect. Asking another healthcare provider for clarification (option D) may not be effective as the responsibility lies with the provider who wrote the prescription.

5. The nurse is caring for a client with a chest tube in place following a pneumothorax. Which finding requires immediate intervention?

• A. Oxygen saturation of 95%
• B. Crepitus around the insertion site
• C. Subcutaneous emphysema
• D. Drainage of 50 ml per hour

Correct answer: C

Rationale: Subcutaneous emphysema requires immediate intervention in a client with a chest tube following a pneumothorax as it can indicate a pneumothorax recurrence or air leak. Oxygen saturation of 95% is within the normal range and does not require immediate intervention. Crepitus around the insertion site can be expected post-procedure and may not necessitate immediate action. Drainage of 50 ml per hour is a normal finding and does not raise immediate concerns.

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