Nursing Elites

1. A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client’s fluid balance is stable at this time?

• A. Decreased calcium levels
• B. Increased phosphorus levels
• C. No adventitious sounds in the lungs
• D. Increased edema in the legs

Correct answer: C

Rationale: The absence of adventitious sounds upon auscultation of the lungs is a key indicator that the client's fluid balance is stable. Adventitious sounds, such as crackles or wheezes, are typically heard in conditions of fluid overload, indicating that the body is retaining excess fluid. Choices A and B, decreased calcium levels and increased phosphorus levels, are common laboratory findings associated with chronic kidney disease (CKD) and are not directly related to fluid balance. Increased edema in the legs is a sign of fluid imbalance, suggesting fluid retention in the tissues, which would not indicate stable fluid balance in a client with CKD on fluid restrictions.

2. The healthcare professional assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory results should the healthcare professional review?

• A. Red blood cell count
• B. Platelet count
• C. Hemoglobin levels
• D. White blood cell count

Correct answer: B

Rationale: The platelet count is the most appropriate laboratory result to review in a client presenting with petechiae and ecchymosis. Petechiae and ecchymosis are indicative of potential bleeding issues, which can be caused by low platelet count or impaired platelet function. Platelets are essential for clotting, and a low platelet count can lead to bleeding disorders. Reviewing the platelet count will provide valuable information about the client's clotting ability. Choice A, red blood cell count, is not typically associated with petechiae and ecchymosis. Hemoglobin levels (Choice C) are more related to anemia than bleeding disorders like thrombocytopenia. White blood cell count (Choice D) is not directly linked to the presence of petechiae and ecchymosis, which are more specific to platelet-related issues.

3. A patient presents with severe chest pain radiating to the left arm. Which of the following diagnostic tests is the priority?

• A. Complete blood count (CBC)
• B. Electrocardiogram (ECG)
• C. Chest X-ray
• D. Serum electrolytes

Correct answer: B

Rationale: In a patient presenting with severe chest pain radiating to the left arm, the priority diagnostic test is an Electrocardiogram (ECG) to assess for myocardial infarction. An ECG can quickly identify changes indicative of ischemia or infarction, guiding prompt management. A Complete Blood Count (CBC) may provide some information but is not the primary test for evaluating chest pain related to myocardial infarction. A Chest X-ray can be useful in assessing lung pathologies or certain cardiac conditions; however, it does not provide immediate information on myocardial infarction, making it a secondary option in this scenario. Serum electrolytes may become important in later stages but do not offer immediate insights into myocardial infarction. Therefore, they are a lower priority compared to obtaining an ECG for timely diagnosis and intervention.

4. After educating a client with a history of renal calculi, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I should drink at least 3 liters of fluid every day.
• B. I will eliminate all dairy or sources of calcium from my diet.
• C. Aspirin and aspirin-containing products can lead to stones.
• D. The doctor can give me antibiotics at the first sign of a stone.

Correct answer: A

Rationale: To prevent the formation of renal calculi, it is essential to maintain adequate hydration as dehydration can contribute to the precipitation of minerals leading to stone formation. Therefore, the correct statement indicating understanding of the teaching is choice A. Increasing fluid intake helps dilute urine and reduces the risk of stone formation. Eliminating all sources of calcium is not recommended as calcium is essential for various bodily functions and eliminating it can lead to other health issues. Aspirin and aspirin-containing products do not directly cause kidney stones. Antibiotics are not used to prevent or treat renal calculi, as they are not caused by bacterial infections.

5. The client is receiving teletherapy radiation for a malignant tumor. Which instruction regarding skin care of the portal site should the nurse provide?

• A. Protect the skin of the radiation portal site from sunlight exposure
• B. Apply moisturizing lotions daily to the radiation portal site
• C. Avoid washing the skin inside the radiation portal site
• D. Remove the ink marks of the portal after each radiation treatment

Correct answer: A

Rationale: Protecting the skin from sunlight exposure is crucial to prevent radiation burns and additional skin damage at the treatment site. Sun exposure can exacerbate skin reactions caused by radiation therapy. Applying moisturizing lotions daily may introduce foreign substances or irritants to the treated area, leading to potential complications. Washing the skin inside the radiation portal site is important for maintaining cleanliness and preventing infections. Removing the ink marks after each treatment is unnecessary and may cause unnecessary skin irritation and trauma.

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