Nursing Elites

1. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?

• A. Contact the provider to request an order for serum electrolytes.
• B. Encourage the patient to consume less fluids.
• C. Report symptoms of hyperkalemia to the provider.
• D. Request an order to increase the patient’s potassium dose.

Correct answer: A

Rationale: Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes to assess the patient's potassium levels. Encouraging the patient to consume less fluids would not address the underlying issue of potential hyperkalemia. Reporting symptoms of hyperkalemia to the provider is not as proactive as directly requesting serum electrolytes. Increasing the patient's potassium dose would worsen hyperkalemia, which is already suspected based on the symptoms presented.

2. A client with gouty arthritis reports tenderness and swelling of the right ankle and great toe. The nurse observes the area of inflammation extends above the ankle. The client receives prescriptions for colchicine and indomethacin. Which instruction should the nurse include in the discharge teaching?

• A. Eat high-protein foods to achieve ideal body weight
• B. Drink at least 8 cups (1920mL) of water per day
• C. Use an electric heating pad when pain is at its worst
• D. Encourage active range of motion to prevent stiffness

Correct answer: B

Rationale: The correct answer is to instruct the client to drink at least 8 cups (1920mL) of water per day. Adequate hydration helps to prevent the formation of uric acid crystals, which can exacerbate gout symptoms. Choice A is incorrect because while maintaining a healthy weight is important, it doesn't directly address gout management. Choice C is incorrect because using an electric heating pad can worsen inflammation. Choice D is incorrect because active range of motion may exacerbate pain and inflammation in the affected joints.

3. During an assessment on a patient brought to the emergency department for treatment for dehydration, the nurse notes a respiratory rate of 26 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 86/50 mm Hg, and a temperature of 39.5° C. The patient becomes dizzy when transferred from the wheelchair to a bed. The nurse observes cool, clammy skin. Which diagnosis does the nurse suspect?

• A. Fluid volume deficit (FVD)
• B. Fluid volume excess (FVE)
• C. Mild extracellular fluid (ECF) deficit
• D. Renal failure

Correct answer: A

Rationale: The nurse should suspect Fluid Volume Deficit (FVD) in this patient. Signs of FVD include elevated temperature, tachycardia, tachypnea, hypotension, orthostatic hypotension, and cool, clammy skin, which align with the patient's assessment findings. Choices B, C, and D are incorrect. Fluid Volume Excess (FVE) typically presents with bounding pulses, elevated blood pressure, dyspnea, and crackles. Mild extracellular fluid (ECF) deficit usually manifests as thirst. Renal failure commonly results in Fluid Volume Excess (FVE) rather than Fluid Volume Deficit (FVD).

4. Which of the following is a key symptom of hypothyroidism?

• A. Weight loss.
• B. Heat intolerance.
• C. Cold intolerance.
• D. Increased appetite.

Correct answer: C

Rationale: Cold intolerance is a key symptom of hypothyroidism because a decreased metabolic rate leads to a reduced ability to regulate body temperature. Weight loss (Choice A) is more commonly associated with hyperthyroidism, where the metabolic rate is increased. Heat intolerance (Choice B) is also more indicative of hyperthyroidism, where excess thyroid hormone leads to an increased sensitivity to heat. Increased appetite (Choice D) is not typically seen in hypothyroidism; instead, individuals with hypothyroidism may experience weight gain due to the slowed metabolism.

5. A client with chronic renal failure is receiving erythropoietin therapy. The nurse should assess the client for which of the following side effects?

• A. Hypotension.
• B. Hypertension.
• C. Hyperglycemia.
• D. Hypercalcemia.

Correct answer: B

Rationale: The correct answer is B: Hypertension. Erythropoietin therapy can lead to an increase in blood pressure, making hypertension a common side effect that the nurse should closely monitor. Hypotension (choice A) is not typically associated with erythropoietin therapy. Hyperglycemia (choice C) and hypercalcemia (choice D) are not commonly linked to erythropoietin therapy in clients with chronic renal failure, making them incorrect choices.

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