Nursing Elites

1. The nurse is preparing to administer an IV dose of ciprofloxacin to a client with a urinary tract infection. Which client data requires the most immediate intervention by the nurse?

• A. Serum creatinine of 4.5 mg/dL (398 μmol/L SI)
• B. Temperature of 101.3°F
• C. Blood pressure of 140/90 mmHg
• D. Heart rate of 88 bpm

Correct answer: A

Rationale: A serum creatinine level of 4.5 mg/dL indicates severe renal impairment, which requires immediate attention before administering ciprofloxacin. Elevated serum creatinine levels suggest decreased kidney function, and giving ciprofloxacin can further harm the kidneys. Monitoring and addressing renal function are crucial to prevent worsening of renal impairment and potential drug toxicity. The temperature, blood pressure, and heart rate are important parameters to assess, but in this scenario, the priority is to address the severe renal impairment before proceeding with ciprofloxacin administration.

2. A female client who is admitted to the mental health unit for opiate dependency is receiving clonidine 0.1 mg PO for withdrawal symptoms. The client begins to complain of feeling nervous and tells the nurse that her bones are itching. Which finding should the nurse identify as a contraindication for administering the medication?

• A. Blood pressure 90/76 mm Hg.
• B. Heart rate of 85 bpm.
• C. Respiratory rate of 20 breaths/minute.
• D. Temperature of 99°F (37.2°C).

Correct answer: A

Rationale: Clonidine can lower blood pressure, so a BP of 90/76 mm Hg may indicate that it is unsafe to administer another dose. In this situation, the low blood pressure reading indicates that the client is already experiencing hypotension, which is a common side effect of clonidine. Administering more clonidine could further lower the blood pressure, leading to potential complications. The heart rate, respiratory rate, and temperature are within normal limits and do not serve as contraindications for administering clonidine in this scenario.

3. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which assessment finding is most concerning?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 24 breaths per minute
• C. Use of accessory muscles
• D. Inspiratory crackles

Correct answer: C

Rationale: The correct answer is C. Use of accessory muscles is the most concerning finding in a client with COPD experiencing an exacerbation. This indicates increased work of breathing and can be a sign of respiratory failure, requiring immediate intervention. Oxygen saturation of 90% is low but not as concerning as the increased work of breathing. A respiratory rate of 24 breaths per minute can be within normal limits. Inspiratory crackles may be present in COPD due to airway inflammation but are not as concerning as the use of accessory muscles.

4. 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.

5. An elderly female client with osteoarthritis reports increasing pain and stiffness in her right knee and asks how to reduce these symptoms. In responding to the client, the nurse recognizes what pathology as the cause of her symptoms?

• A. Destruction of joint cartilage.
• B. Inflammation of synovial membrane.
• C. Formation of bone spurs.
• D. Reduction of joint space.

Correct answer: A

Rationale: Corrected Rationale: Osteoarthritis typically involves the destruction of joint cartilage, leading to pain and stiffness. This destruction of joint cartilage results in bone rubbing against bone, causing pain and reduced mobility. Choices B, C, and D are incorrect. Inflammation of the synovial membrane (choice B) is more commonly associated with rheumatoid arthritis. Formation of bone spurs (choice C) and reduction of joint space (choice D) are manifestations that can occur as a result of osteoarthritis but are not the primary pathology responsible for the symptoms of pain and stiffness.

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