Nursing Elites

1. A child is diagnosed with acquired aplastic anemia. The nurse knows that this child has the best prognosis with which treatment regimen?

• A. blood transfusion
• B. chemotherapy
• C. bone marrow transplantation
• D. immunosuppressive therapy

Correct answer: C

Rationale: In the case of acquired aplastic anemia, bone marrow transplantation offers the best chance of cure as it replaces the abnormal stem cells with healthy ones. Blood transfusion may provide temporary relief by replacing blood cells, but it does not address the root cause of the condition. Chemotherapy may be used in some cases, but it is not the preferred treatment for acquired aplastic anemia. While immunosuppressive therapy can be effective, especially in patients who are not candidates for a bone marrow transplant, it is not the first-line treatment and does not offer the same potential for a cure as bone marrow transplantation.

2. IV potassium chloride (KCl) 60 mEq is prescribed for the treatment of a patient with severe hypokalemia. Which action should the nurse take?

• A. Administer the KCl as a rapid IV bolus.
• B. Infuse the KCl at a rate of 10 mEq/hour.
• C. Only give the KCl through a central venous line.
• D. Discontinue cardiac monitoring during the infusion.

Correct answer: B

Rationale: The correct action for the nurse to take is to infuse the KCl at a rate of 10 mEq/hour. Rapid IV infusion of KCl can lead to cardiac arrest due to its potential for causing hyperkalemia. While KCl can be administered through peripheral veins, central venous lines are not necessary unless specified. It is crucial to continue cardiac monitoring during potassium infusion to promptly identify and manage any potential dysrhythmias that may occur.

3. A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse?

• A. Arterial blood pH is 7.32.
• B. Serum calcium is 18 mg/dL.
• C. Serum potassium is 5.1 mEq/L
• D. Arterial oxygen saturation is 91%.

Correct answer: B

Rationale: The correct answer is B. A serum calcium level of 18 mg/dL is significantly elevated, posing a high risk for cardiac dysrhythmias. Immediate action is required to initiate cardiac monitoring and notify the healthcare provider. While the abnormalities in arterial blood pH, serum potassium, and arterial oxygen saturation also need attention, they are not as immediately life-threatening as the critically high serum calcium level. Therefore, addressing the serum calcium level takes precedence in this scenario.

4. A male client with unstable angina needs a cardiac catheterization. So the healthcare provider explains the risks and benefits of the procedure and then leaves to set up for the procedure. When the nurse presents the consent form for signature, the client hesitates and asks how the wires will keep his heart going. Which action should the nurse take?

• A. Answer the client's specific questions with a short, understandable explanation
• B. Postpone the procedure until the client understands the risks and benefits
• C. Call the client's next of kin and ask them to provide verbal consent
• D. Page the healthcare provider to return and provide additional explanation

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to page the healthcare provider to return and provide additional explanation. It is crucial for the client to have a clear understanding of the procedure, including its risks and benefits, before signing the consent form. While the nurse can provide general information, the detailed explanation of how the procedure works and its effects should come from the healthcare provider who will perform the procedure. Postponing the procedure until the client understands is appropriate, but the immediate need is to clarify the client's concerns with the healthcare provider. Calling the client's next of kin for verbal consent is not the correct course of action as the client is present and able to provide consent after receiving adequate information.

5. A patient who has small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the healthcare provider about which assessment finding?

• A. Reported weight gain
• B. Serum hematocrit of 42%
• C. Serum sodium level of 120 mEq/L
• D. Total urinary output of 280 mL during the past 8 hours

Correct answer: C

Rationale: The correct answer is C, a serum sodium level of 120 mEq/L. Hyponatremia is the most important finding to report in SIADH. SIADH causes water retention and a decrease in serum sodium levels. Hyponatremia can lead to confusion and other central nervous system effects and requires treatment. Adequate kidney function is indicated by a urinary output of at least 30 mL/hr. A hematocrit level of 42% is normal. Weight gain is expected due to water retention in SIADH.

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