Nursing Elites

1. 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.

2. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?

• A. Your immune system becomes less effective as you age.
• B. Low estrogen levels can make the tissue more susceptible to infection.
• C. You should be more careful with your personal hygiene in this area.
• D. It is likely that you have an untreated sexually transmitted disease.

Correct answer: B

Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.

3. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?

• A. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.
• B. Continue the intravenous fluids as ordered and reassess the patient frequently.
• C. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.
• D. Stop the intravenous fluids and notify the provider of the assessment findings.

Correct answer: D

Rationale: The patient’s potassium level is within normal limits, but the decreased urine output indicates the patient should not receive additional IV potassium. Increasing potassium chloride to 40 mEq/L is not needed as the level is normal. Stopping the IV fluids is appropriate due to the decreased urine output, which suggests potential fluid overload. The nurse should notify the provider of the assessment findings for further management. Increasing the rate of fluids to 200 mL/hour is not recommended without addressing the decreased urine output first.

4. A 57-year-old male client is scheduled to have a stress-thallium test the following morning and is NPO after midnight. At 0130, he is agitated because he cannot eat and is demanding food. Which response is best for the nurse to provide to this client?

• A. I'm sorry sir, you have a prescription for nothing by mouth from midnight tonight.
• B. I will let you have one cracker, but that is all you can have for the rest of tonight.
• C. What did the healthcare provider tell you about the test you are having tomorrow?
• D. The test you are having tomorrow requires that you have nothing by mouth tonight.

Correct answer: D

Rationale: Being direct and explaining to the client that the test requires him to be NPO, is the most therapeutic statement because the nurse is responding to the client's question and providing him the reason why.

5. A client has an elevated blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?

• A. Assess the client’s dietary habits.
• B. Inquire about the client's use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• C. Hold the client’s metformin (Glucophage).
• D. Contact the health care provider immediately.

Correct answer: A

Rationale: An elevated blood urea nitrogen (BUN)/creatinine ratio can indicate various conditions such as dehydration, urinary obstruction, catabolism, or a high-protein diet. The initial action the nurse should take is to assess the client’s dietary habits to determine if the elevated ratio is related to diet. Inquiring about the use of NSAIDs is important as they can impact kidney function, but dietary causes should be ruled out first. Holding metformin or contacting the health care provider without assessing the dietary habits would be premature actions as they may not address the underlying cause of the elevated BUN/creatinine ratio.

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