The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which assessment finding is most concerning?

A. Increased fatigue

B. Headache

C. Elevated blood pressure

D. Low urine output

Correct Answer: C
Rationale: In a client with chronic kidney disease (CKD) receiving erythropoietin therapy, an elevated blood pressure is the most concerning assessment finding. This finding can indicate worsening hypertension, which requires prompt intervention to prevent complications such as cardiovascular events or further kidney damage. Increased fatigue (Choice A) is a common symptom in CKD and can be expected with the condition itself or the treatment. Headache (Choice B) can also occur but is less specific to CKD or its treatment. Low urine output (Choice D) is a concern in CKD but may not be directly related to erythropoietin therapy.

A client with a history of hypertension 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. Pulmonary function tests (PFTs)
• D. Arterial blood gases (ABGs)

Correct Answer: A
Rationale: The correct answer is A: Electrocardiogram (ECG). An ECG should be performed first to assess for cardiac ischemia in a client presenting with shortness of breath and chest pain. This test helps in evaluating the electrical activity of the heart and can identify signs of myocardial infarction or other cardiac issues. Choice B, Chest X-ray, may be ordered after the ECG to assess for pulmonary conditions like pneumonia or effusions. Choice C, Pulmonary function tests (PFTs), are used to evaluate lung function and are not the primary diagnostic tests for a client with symptoms of cardiac origin. Choice D, Arterial blood gases (ABGs), may provide information about oxygenation but are not the initial test indicated for a client with suspected cardiac issues.

A client with diabetes mellitus is admitted with a blood glucose level of 600 mg/dl and is unresponsive. Which laboratory value is most concerning?

• A. Serum potassium of 3.0 mEq/L
• B. Serum glucose of 200 mg/dl
• C. Serum pH of 7.30
• D. Serum sodium of 135 mEq/L

Correct Answer: C
Rationale: In a client with Hyperosmolar Hyperglycemic State (HHS), a serum pH of 7.30 is the most concerning value as it indicates acidosis, a life-threatening condition that requires immediate intervention. Choices A, B, and D are not the most concerning in this scenario. A low serum potassium level (Choice A) may be expected due to cellular shift in hyperglycemia, a serum glucose level of 200 mg/dl (Choice B) is not as concerning compared to the extremely high initial glucose level, and a serum sodium level of 135 mEq/L (Choice D) is within the normal range and not the immediate priority.

The nurse is assessing a client with chronic heart failure who is receiving furosemide (Lasix). Which assessment finding is most concerning?

• A. Heart rate of 60 beats per minute
• B. Blood pressure of 110/70 mmHg
• C. Elevated liver enzymes
• D. Elevated blood glucose level

Correct Answer: C
Rationale: Elevated liver enzymes are most concerning in a client with chronic heart failure as they may indicate liver congestion or worsening heart failure, requiring immediate intervention. Elevated liver enzymes can be a sign of hepatotoxicity or liver damage, which could be a result of furosemide (Lasix) use. Monitoring liver function is crucial in patients taking furosemide due to the risk of hepatotoxicity. A heart rate of 60 beats per minute and a blood pressure of 110/70 mmHg are within normal ranges for a client with chronic heart failure. An elevated blood glucose level may be expected due to the effects of furosemide but is not as immediately concerning as elevated liver enzymes.

A client with a history of chronic heart failure is admitted with shortness of breath. Which laboratory value should be closely monitored?

• A. Serum sodium level
• B. Serum potassium level
• C. Serum creatinine level
• D. Hemoglobin level

Correct Answer: B
Rationale: Corrected Rationale: In a client with chronic heart failure, serum potassium levels should be closely monitored to assess for hyperkalemia, which can worsen heart failure. Monitoring serum sodium levels is not the priority in this case. Serum creatinine level monitoring is more related to kidney function than heart failure. Hemoglobin levels are important but not the primary concern when assessing heart failure exacerbation.