Nursing Elites

1. The nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for hemodialysis. Which assessment finding is most concerning?

• A. Blood pressure of 110/70 mmHg
• B. Heart rate of 110 beats per minute
• C. Fever of 100.4°F
• D. Respiratory rate of 24 breaths per minute

Correct answer: C

Rationale: A fever of 100.4°F is the most concerning assessment finding in a client with ESRD scheduled for hemodialysis. This elevation in temperature may indicate an underlying infection, which can lead to serious complications in individuals with compromised renal function. Prompt intervention is necessary to prevent the spread of infection and deterioration of the client's condition. The other vital signs mentioned, such as blood pressure, heart rate, and respiratory rate, while important to monitor, are within acceptable ranges and do not pose an immediate threat like a fever indicative of infection.

2. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which intervention should the nurse implement first?

• A. Administer a bronchodilator as prescribed.
• B. Assess the client's respiratory rate.
• C. Assess the client's oxygen saturation.
• D. Elevate the head of the bed.

Correct answer: C

Rationale: Assessing the client's oxygen saturation is crucial in a client with COPD receiving supplemental oxygen to ensure adequate oxygenation. This assessment helps determine if the current oxygen therapy is effective or if adjustments are necessary. While administering a bronchodilator is important in managing COPD, assessing oxygen saturation takes precedence to address the client's immediate oxygen needs. Assessing the respiratory rate is also important but evaluating oxygen saturation provides more direct information about the client's oxygen status. Elevating the head of the bed can improve ventilation but is not the priority when assessing oxygen saturation in a client with COPD receiving supplemental oxygen.

3. A client with hyperthyroidism is admitted to the postoperative unit after subtotal thyroidectomy. Which of the client's serum laboratory values requires intervention by the nurse?

• A. Total calcium 5.0 mg/dL.
• B. Serum sodium 140 mEq/L.
• C. Serum potassium 4.0 mEq/L.
• D. Serum glucose 90 mg/dL.

Correct answer: A

Rationale: The correct answer is A. A calcium level of 5.0 mg/dL is critically low and could indicate hypoparathyroidism, a possible complication after thyroidectomy. Low calcium levels can lead to tetany, seizures, and cardiac dysrhythmias, requiring immediate intervention. Choices B, C, and D fall within the normal range and do not require immediate intervention in this scenario.

4. A client with a history of chronic kidney disease is scheduled for a CT scan with contrast. Which laboratory value should the nurse review before the procedure?

• A. Serum potassium
• B. Blood urea nitrogen (BUN)
• C. Serum creatinine
• D. Serum glucose

Correct answer: C

Rationale: Before a CT scan with contrast, the nurse should review the serum creatinine level. This is crucial in assessing kidney function because contrast agents can potentially worsen renal function, leading to contrast-induced nephropathy. Monitoring serum creatinine helps in identifying patients at risk and taking necessary precautions. Serum potassium (Choice A) is important in conditions like hyperkalemia but is not the priority before a contrast CT scan. Blood urea nitrogen (BUN) (Choice B) is another renal function test but is not as specific as serum creatinine for assessing kidney function. Serum glucose (Choice D) is important in monitoring blood sugar levels, especially in diabetic patients, but it is not directly related to the risk of contrast-induced nephropathy in this scenario.

5. When assessing a client with left-sided heart failure, which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Monitor the client's urine output.
• C. Administer a loop diuretic as prescribed.
• D. Administer morphine as prescribed.

Correct answer: A

Rationale: Administering oxygen therapy is the initial intervention for a client with left-sided heart failure. This action is crucial in improving oxygen levels and reducing pulmonary congestion. Monitoring urine output is important for assessing renal function in heart failure, but it is not the priority over ensuring adequate oxygenation. Administering loop diuretics helps manage fluid overload but should come after addressing oxygen needs. Morphine may be indicated for pain or anxiety in some cases, but it is not the primary intervention for left-sided heart failure.

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