Nursing Elites

1. What is the primary purpose of administering anticoagulants to a patient with atrial fibrillation?

• A. To reduce blood pressure.
• B. To prevent clot formation.
• C. To prevent arrhythmias.
• D. To reduce inflammation.

Correct answer: B

Rationale: The primary purpose of administering anticoagulants to a patient with atrial fibrillation is to prevent clot formation. Patients with atrial fibrillation are at an increased risk of forming blood clots in the heart, which can lead to stroke if they travel to the brain. Anticoagulants help to reduce this risk by inhibiting the clotting process. Therefore, choices A, C, and D are incorrect because anticoagulants do not primarily aim to reduce blood pressure, prevent arrhythmias, or reduce inflammation in patients with atrial fibrillation.

2. A nurse contacts the healthcare provider after reviewing a client’s laboratory results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of 1.0 mg/dL. For which action should the nurse recommend a prescription?

• A. Intravenous fluids
• B. Hemodialysis
• C. Fluid restriction
• D. Urine culture and sensitivity

Correct answer: A

Rationale: The normal range for BUN is 10 to 20 mg/dL, and for creatinine, it is 0.6 to 1.2 mg/dL in males and 0.5 to 1.1 mg/dL in females. Creatinine is a more specific marker for kidney function compared to BUN. In this case, the client's creatinine level is within the normal range, indicating a non-renal cause for the elevated BUN. Dehydration is a common cause of increased BUN, so the appropriate action would be to recommend intravenous fluids to address the dehydration. Fluid restriction is not indicated as the client needs hydration. Hemodialysis is not appropriate for dehydration and is typically reserved for renal failure. The laboratory results do not suggest an infection, making a urine culture and sensitivity unnecessary in this scenario.

3. A nurse reviews a female client’s laboratory results. Which result from the client’s urinalysis should the nurse recognize as abnormal?

• A. pH 5.6
• B. Ketone bodies present
• C. Specific gravity of 1.020
• D. Clear and yellow color

Correct answer: B

Rationale: The correct answer is B: Ketone bodies present. Ketone bodies in urine indicate abnormal metabolism, specifically the incomplete breakdown of fatty acids. Normally, there should be no ketones present in urine. Ketone bodies are produced when the body uses fat sources instead of glucose for cellular energy. A pH range between 4.6 and 8, a specific gravity between 1.005 and 1.030, and clear yellow color in urine are considered normal findings for a female client’s urinalysis. Therefore, options A, C, and D are within normal ranges and not indicative of abnormal results in the urinalysis.

4. A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement?

• A. Administer 20 mEq of potassium chloride.
• B. Initiate continuous cardiac monitoring.
• C. Arrange a consultation with the dietitian.
• D. Educate about the side effects of diuretics.

Correct answer: B

Rationale: Hypokalemia, defined as a serum potassium level below the normal range of 3.5 to 5 mEq/L, can lead to changes in myocardial irritability and ECG waveform, potentially causing life-threatening dysrhythmias. Therefore, the priority action for the nurse is to initiate continuous cardiac monitoring to promptly detect any abnormal heart rhythms or ventricular ectopy. This monitoring is crucial for assessing the impact of potassium replacement therapy on the cardiac rhythm and ensuring the safety of the client. While administering potassium chloride is important for correcting the hypokalemia, it should occur after cardiac monitoring is in place. Consulting with a dietitian and educating about diuretic side effects are relevant aspects of care but are not the immediate priority in this situation where cardiac monitoring takes precedence for timely intervention.

5. After a session of hemodialysis, the nurse should monitor the client for which of the following complications of hemodialysis?

• A. Hyperkalemia.
• B. Hypotension.
• C. Infection.
• D. Fever.

Correct answer: B

Rationale: The correct answer is 'B: Hypotension.' Hypotension is a common complication of hemodialysis because fluid removal during the process can lead to a drop in blood pressure. The nurse should closely monitor the client for signs of hypotension such as dizziness, lightheadedness, or a decrease in blood pressure readings. Choice 'A: Hyperkalemia' is incorrect because hemodialysis actually helps lower potassium levels by removing excess potassium from the blood. Choice 'C: Infection' is incorrect as it is not a direct complication of hemodialysis but rather a risk associated with invasive procedures. Choice 'D: Fever' is incorrect as fever is not a typical immediate post-hemodialysis complication unless an underlying infection is present.

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