NCLEX NCLEX-PN
Nclex Questions Management of Care
1. The healthcare professional seeks to assess the renal function of an elderly client who is about to receive a nephrotoxic medication. Which of the following labs provides the best indicator for renal function?
- A. urinalysis
- B. creatinine and blood urea nitrogen
- C. chemistry of electrolytes
- D. creatinine clearance
Correct answer: creatinine clearance
Rationale: In the context of an elderly client, assessing renal function before administering a nephrotoxic medication is crucial. While urinalysis and blood urea nitrogen provide valuable information on hydration status and overall health clues, they are not specific indicators of renal function. The chemistry of electrolytes may show abnormalities in renal failure, but it does not directly measure the kidneys' ability to eliminate waste. Creatinine clearance, on the other hand, is considered the best indicator for renal function in the elderly. This test accounts for decreases in lean body mass that can affect blood creatinine levels and is widely used to estimate the glomerular filtration rate, reflecting the kidneys' filtration capability. Therefore, creatinine clearance is the most appropriate lab test to assess renal function in this scenario.
2. Why is it often necessary to draw a complete blood count and differential (CBC/differential) when a client is being treated with an antiepileptic drug (AED)?
- A. The hematocrit is adversely affected due to increased vascular volume.
- B. AEDs can lead to blood dyscrasia as a side effect.
- C. AEDs may cause aplastic anemia and megaloblastic anemia.
- D. Some AEDs induce white blood cell reduction.
Correct answer: B
Rationale: When a client is being treated with antiepileptic drugs (AEDs), it is essential to monitor for potential side effects on blood parameters. Some AEDs can lead to blood dyscrasia, which includes conditions like aplastic anemia and megaloblastic anemia. Therefore, drawing a complete blood count and differential helps in identifying these adverse effects early. Choices A, C, and D are incorrect because the primary concern when monitoring blood parameters in clients on AEDs is the risk of blood dyscrasia, not changes in hematocrit due to vascular volume, white blood cell reduction, or immune modulation.
3. During a hospital program about in vitro fertilization, a television crew arrives to film for a series on hospital services. What action should the nurse conducting the program take?
- A. Ask the television crew to interview the individuals attending the program individually.
- B. Allow the television crew to videotape the program as long as they do not publicize that the program is about in vitro fertilization.
- C. Explain to the television crew that videotaping is not allowed.
- D. Allow the television crew to videotape the program.
Correct answer: Explain to the television crew that videotaping is not allowed.
Rationale: Privacy is a client’s right to be free from unwanted intrusion into their private affairs. Videotaping constitutes an invasion of a client’s privacy, and written permission is required from the client for actions such as photographing or videotaping. Therefore, the nurse must explain to the television crew that videotaping is not allowed to protect the attendees' privacy. Option A is incorrect as it still involves recording the individuals, breaching their privacy. Option B is incorrect because allowing videotaping without consent violates privacy rights. Option D is incorrect as it disregards the need for consent and privacy protection.
4. Which of the following ethnic groups is at highest risk in the United States for pesticide-related injuries?
- A. Native American
- B. Asian-Pacific
- C. Norwegian
- D. Hispanic
Correct answer: Hispanic
Rationale: Hispanic people are at the highest risk in the United States for pesticide-related injuries due to their significant representation among migrant workers in agricultural settings. Working in such environments exposes them to pesticides more frequently, thus elevating their risk compared to other ethnic groups. In contrast, Native American, Asian-Pacific, and Norwegian populations are not as commonly engaged in agricultural work involving pesticide exposure, which makes them less susceptible to pesticide-related injuries. Therefore, the correct answer is Hispanic.
5. High uric acid levels can develop in clients who are receiving chemotherapy. This can be caused by:
- A. the inability of the kidneys to excrete the drug metabolites.
- B. rapid cell catabolism.
- C. toxic effects of the prophylactic antibiotics that are given concurrently.
- D. the altered blood pH from the acidic nature of the drugs.
Correct answer: rapid cell catabolism.
Rationale: The correct answer is 'rapid cell catabolism.' During chemotherapy, rapid cell destruction occurs, leading to an increase in uric acid levels as a byproduct of cell breakdown. High uric acid levels are primarily a result of the rapid breakdown of cells during chemotherapy, not due to the kidneys' inability to excrete drug metabolites (Choice A). The prophylactic antibiotics given concurrently do not directly cause high uric acid levels (Choice C). The altered blood pH from the acidic nature of the drugs (Choice D) is not a direct cause of elevated uric acid levels; the main mechanism is the rapid cell catabolism that occurs during chemotherapy.
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