Nursing Elites

1. A client with a history of chronic kidney disease (CKD) is admitted with hyperkalemia. Which clinical finding is most concerning?

• A. Peaked T waves on the ECG
• B. Bradycardia
• C. Muscle weakness
• D. Decreased deep tendon reflexes

Correct answer: A

Rationale: Peaked T waves on the ECG are the most concerning finding in a client with hyperkalemia. Hyperkalemia can lead to serious cardiac complications, including arrhythmias and cardiac arrest. Peaked T waves are a classic ECG finding associated with hyperkalemia and indicate the need for immediate intervention. Bradycardia, muscle weakness, and decreased deep tendon reflexes can also be seen in hyperkalemia, but the presence of peaked T waves signifies a higher risk of cardiac events, making it the most concerning finding in this scenario.

2. The nurse is caring for a client with a history of atrial fibrillation who is receiving warfarin (Coumadin). Which laboratory value should be closely monitored?

• A. Serum potassium level
• B. Prothrombin time (PT)
• C. International Normalized Ratio (INR)
• D. Serum sodium level

Correct answer: C

Rationale: The correct answer is C, International Normalized Ratio (INR). The INR should be closely monitored in a client receiving warfarin (Coumadin) to assess the effectiveness and safety of anticoagulation therapy. Monitoring the INR helps ensure that the client is within the therapeutic range for anticoagulation to prevent complications such as bleeding or clotting. Choices A, B, and D are incorrect. While monitoring electrolyte levels like serum potassium and sodium is important in overall client care, they are not specific to monitoring the effects of warfarin therapy. Prothrombin time (PT) is a component of INR and helps in monitoring warfarin therapy, but INR gives a standardized result that is independent of the laboratory method used, making it the preferred choice for monitoring warfarin therapy.

3. An adult female client with chronic kidney disease (CKD) asks the nurse if she can continue taking her over-the-counter medications. Which medication poses the greatest threat to this client?

• A. Magnesium hydroxide (Maalox).
• B. Birth control pills.
• C. Cough syrup containing codeine.
• D. Cold medication containing alcohol.

Correct answer: A

Rationale: The correct answer is A, Magnesium hydroxide (Maalox). In clients with chronic kidney disease (CKD), magnesium can accumulate to toxic levels as the kidneys are unable to excrete it efficiently. This can lead to hypermagnesemia, causing serious and potentially life-threatening complications. Birth control pills (choice B) are metabolized mainly by the liver and do not pose a significant threat to clients with CKD. Cough syrup containing codeine (choice C) should be used cautiously in CKD due to the risk of respiratory depression but does not pose as great a threat as magnesium accumulation. Cold medication containing alcohol (choice D) should be avoided in CKD but does not present the same level of danger as magnesium toxicity.

4. A client with type 2 diabetes is admitted with hyperglycemic hyperosmolar syndrome (HHS). Which clinical finding is most concerning to the nurse?

• A. Serum glucose of 500 mg/dL
• B. Blood pressure of 140/90 mmHg
• C. Serum osmolarity of 320 mOsm/kg
• D. Serum pH of 7.30

Correct answer: C

Rationale: A serum osmolarity of 320 mOsm/kg is the most concerning finding in a client with hyperglycemic hyperosmolar syndrome (HHS) as it indicates severe dehydration and hypertonicity. This high serum osmolarity level can lead to neurological complications and requires immediate intervention to prevent further deterioration. Serum glucose levels, blood pressure, and serum pH are important parameters to monitor in HHS, but a significantly elevated serum osmolarity poses a higher risk of complications and warrants urgent attention. High serum glucose levels, like 500 mg/dL, are expected in HHS but do not directly indicate the severity of dehydration. Blood pressure of 140/90 mmHg is within normal limits and may not be directly related to the acute complications of HHS. A serum pH of 7.30 suggests acidosis, which is important to address but may not be as immediately concerning as severe dehydration indicated by high serum osmolarity.

5. A 12-year-old boy has a body mass index (BMI) of 28, a systolic pressure, and a glycosylated hemoglobin (HBA1C) of 7.8%. Which selection indicates that his mother understands the management of his diet?

• A. One whole-wheat bagel with cream cheese, two strips of bacon, six ounces of orange juice.
• B. Two eggs with toast and butter, 8 ounces of milk.
• C. Fresh fruit salad with low-fat yogurt.
• D. Pancakes with syrup and sausage links.

Correct answer: C

Rationale: The correct answer is C. Fresh fruit salad with low-fat yogurt is a healthier choice for managing the diet of a 12-year-old boy with a high BMI and elevated HBA1C. This choice provides a good balance of nutrients, fiber, and low-fat content, helping to lower BMI and maintain healthy blood sugar levels. Choices A, B, and D are less ideal as they contain higher levels of refined carbohydrates, saturated fats, and sugars, which can contribute to weight gain and worsen blood sugar control in this scenario.

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