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. The patient weighs 75 kg and is receiving IV fluids at a rate of 50 mL/hour, having consumed 100 mL orally in the past 24 hours. What action will the nurse take?

• A. Contact the provider to ask about increasing the IV rate to 90 mL/hour.
• B. Discuss with the provider the need to increase the IV rate to 150 mL/hour.
• C. Encourage the patient to drink more water so the IV can be discontinued.
• D. Instruct the patient to drink 250 mL of water every 8 hours.

Correct answer: A

Rationale: The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. For a patient weighing 75 kg, the minimum intake should be 2250 mL/day. The patient is currently receiving 1200 mL IV and 100 mL orally, totaling 1300 mL. Increasing the IV rate to 90 mL/hour would provide a total of 2160 mL, which could meet the patient's needs if oral intake continues. Option B suggests increasing the IV rate to 150 mL/hour, resulting in an excessive fluid intake of 3600 mL/day, surpassing the recommended amount. Option C, encouraging increased fluid intake, is not recommended as the patient is already struggling with fluid intake. Option D, instructing the patient to drink 250 mL of water every 8 hours, would still fall short of the required fluid intake of 2250 mL/day.

3. The healthcare provider is assessing a client who is receiving hemodialysis for the first time. Which of the following findings should be reported to the healthcare provider immediately?

• A. Blood pressure of 150/90 mm Hg.
• B. Nausea and vomiting.
• C. Fatigue.
• D. Headache.

Correct answer: B

Rationale: Nausea and vomiting are critical symptoms that should be reported immediately when a client is receiving hemodialysis for the first time. These symptoms could indicate a severe complication, such as hypotension, infection, electrolyte imbalance, or other adverse reactions to the procedure. It is essential to address these symptoms promptly to prevent further complications or harm to the client. Choices A, C, and D are not immediate concerns during the first hemodialysis session and can be addressed appropriately after addressing the urgent issue of nausea and vomiting.

4. A nurse teaches a client who is recovering from a nephrectomy secondary to kidney trauma. Which statement should the nurse include in this client’s teaching?

• A. Since you only have one kidney, a salt and fluid restriction is required.
• B. Your therapy will include hemodialysis while you recover.
• C. Medication will be prescribed to control your high blood pressure.
• D. You need to avoid participating in contact sports like football.

Correct answer: D

Rationale: Clients with one kidney need to avoid contact sports because the kidneys are easily injured. The client will not be required to restrict salt and fluids, end up on dialysis, or have new hypertension because of the nephrectomy.

5. A client with chronic renal failure is receiving epoetin alfa (Epogen). The nurse should assess the client for which of the following complications?

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

Correct answer: A

Rationale: The correct answer is A: Hypertension. Epoetin alfa (Epogen) is known to increase blood pressure by stimulating red blood cell production. Monitoring for hypertension is crucial to prevent complications such as heart failure or stroke. Choices B, C, and D are incorrect because hypotension, hyperglycemia, and edema are not typically associated with epoetin alfa therapy in clients with chronic renal failure.

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