Nursing Elites

1. A client with a history of chronic kidney disease is receiving erythropoietin therapy. Which finding indicates that the therapy is effective?

• A. Hemoglobin of 12 g/dL.
• B. Reticulocyte count of 1%.
• C. Blood pressure of 130/80 mm Hg.
• D. Serum ferritin level of 100 ng/mL.

Correct answer: A

Rationale: The correct answer is A. A hemoglobin level of 12 g/dL is an indicator of effective erythropoietin therapy as it shows an increase in red blood cell production. Reticulocyte count (choice B) reflects the bone marrow's response to anemia but does not directly confirm the effectiveness of erythropoietin therapy. Blood pressure (choice C) and serum ferritin level (choice D) are not specific indicators of the effectiveness of erythropoietin therapy for chronic kidney disease.

2. A client with a history of diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which finding requires immediate intervention?

• A. Blood glucose of 200 mg/dL.
• B. Serum bicarbonate of 20 mEq/L.
• C. Blood pressure of 140/90 mm Hg.
• D. Urine output of 50 mL in 4 hours.

Correct answer: D

Rationale: In a client with diabetic ketoacidosis (DKA), urine output of 50 mL in 4 hours indicates oliguria, which is a concerning sign of decreased renal perfusion and potential renal failure. This finding requires immediate intervention to prevent further deterioration of kidney function.\n\nChoice A (Blood glucose of 200 mg/dL) is elevated but not the most urgent concern in this scenario. Choice B (Serum bicarbonate of 20 mEq/L) reflects metabolic acidosis, which is expected in DKA but does not require immediate intervention. Choice C (Blood pressure of 140/90 mm Hg) is slightly elevated but not acutely concerning in the context of DKA.

3. The nurse is caring for a client with Addison's disease. Which finding requires immediate intervention?

• A. Hyperpigmentation of the skin.
• B. Low blood pressure.
• C. Nausea and vomiting.
• D. Hypoglycemia.

Correct answer: B

Rationale: Low blood pressure in a client with Addison's disease requires immediate intervention as it can indicate an Addisonian crisis, a life-threatening condition that necessitates prompt treatment. Hyperpigmentation of the skin is a characteristic finding in Addison's disease but does not require immediate intervention. Nausea and vomiting can be managed symptomatically in Addison's disease. While hypoglycemia needs attention, it is not the most critical finding requiring immediate intervention in this context.

4. During a home visit, the nurse observes that a client with limited mobility has difficulty preparing meals. What should the nurse do first?

• A. suggest that the client use a meal delivery service
• B. assist the client in meal planning
• C. refer the client to a dietitian
• D. educate the client on easy-to-prepare healthy meals

Correct answer: B

Rationale: Assisting the client in meal planning is the most appropriate initial action as it addresses the immediate issue of meal preparation. By helping the client plan meals according to their dietary needs and limitations, the nurse can support the client in maintaining a healthy diet despite limited mobility. While suggesting a meal delivery service (Choice A) may be a viable option, assisting in meal planning allows for more personalized and sustainable solutions. Referring the client to a dietitian (Choice C) may be necessary for specialized nutritional advice but is not the first step in addressing the immediate concern. Educating the client on easy-to-prepare healthy meals (Choice D) could be beneficial, but meal planning is a more comprehensive approach to ensure the client's dietary needs are met consistently.

5. A client with chronic renal failure is scheduled for hemodialysis in the morning. Which pre-dialysis medication should the nurse withhold until after the dialysis treatment is completed?

• A. Calcium carbonate (Os-Cal)
• B. Furosemide (Lasix)
• C. Spironolactone (Aldactone)
• D. Multivitamins

Correct answer: B

Rationale: The correct answer is B: Furosemide (Lasix). Furosemide is a diuretic that promotes fluid loss, and giving it before hemodialysis can lead to excessive fluid loss during the treatment, potentially causing hypovolemia. Withholding furosemide until after the dialysis session helps in preventing this complication. Choices A, C, and D are incorrect because calcium carbonate, spironolactone, and multivitamins are not typically contraindicated before hemodialysis in clients with chronic renal failure.

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