Nursing Elites

1. A client with chronic kidney disease (CKD) is experiencing hyperkalemia. Which intervention should the nurse implement to address this condition?

• A. Administer calcium gluconate.
• B. Encourage a diet high in potassium.
• C. Provide potassium supplements.
• D. Restrict sodium intake.

Correct answer: A

Rationale: Administering calcium gluconate is the appropriate intervention for a client with hyperkalemia. Calcium gluconate helps stabilize the heart by counteracting the effects of high potassium levels and reducing the risk of cardiac complications in individuals with hyperkalemia. Choices B, C, and D are incorrect. Encouraging a diet high in potassium or providing potassium supplements would exacerbate hyperkalemia. Restricting sodium intake is not directly related to addressing hyperkalemia.

2. After undergoing rigid fixation for a mandibular fracture from a fight, what area of care should the nurse prioritize for discharge education for this client?

• A. Resumption of activities of daily living
• B. Pain control
• C. Promotion of adequate nutrition
• D. Strategies for promoting adequate nutrition

Correct answer: C

Rationale: The correct answer is promoting adequate nutrition. Following rigid fixation for a mandibular fracture, the client may have limitations in jaw movement, which can affect their ability to eat properly. Prioritizing education on promoting adequate nutrition will help ensure the client's nutritional needs are met during the recovery period.

3. A client with hypothyroidism is started on levothyroxine (Synthroid). Which statement by the client indicates a need for further teaching?

• A. I will take this medication every morning before breakfast.
• B. I should have my thyroid levels checked regularly.
• C. If I lose weight, I may need an increased dose.
• D. I can stop taking this medication once my symptoms improve.

Correct answer: D

Rationale: The correct answer is D. Levothyroxine is typically a lifelong therapy for hypothyroidism. It should not be discontinued even if symptoms improve because the medication helps replace the deficient thyroid hormone. Stopping the medication prematurely can lead to a recurrence of symptoms and potential complications. Patients must understand the importance of continuous levothyroxine therapy and the necessity of regular follow-up with their healthcare provider to monitor thyroid levels and adjust the dosage as needed.

4. An outcome for treatment of peripheral vascular disease is, 'The client will have decreased venous congestion.' What client behavior would indicate to the nurse that this outcome has been met?

• A. Avoids prolonged sitting or standing.
• B. Avoids trauma and irritation to skin.
• C. Wears protective shoes.
• D. Quits smoking.

Correct answer: A

Rationale: The correct answer is A: 'Avoids prolonged sitting or standing.' In clients with peripheral vascular disease, decreased venous congestion is a desired outcome. Avoiding prolonged sitting or standing helps improve venous return and reduces congestion in the lower extremities, contributing to the achievement of this treatment goal.

5. The healthcare provider in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing?

• A. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96
• B. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy
• C. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease
• D. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea

Correct answer: C

Rationale: The 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease may need referral for genetic testing. Polycystic kidney disease is an autosomal dominant disorder that can be asymptomatic until later in life. Presymptomatic testing can provide valuable information for guiding lifestyle and family planning decisions. The other patients do not present indications for genetic testing based on the information provided in their health histories. The 35-year-old patient's maternal grandparents' strokes are not indicative of a need for genetic testing. The 18-year-old patient's child having cerebral palsy is not a direct indication for genetic testing of the patient herself. The 50-year-old patient's symptoms are more likely related to smoking and respiratory issues, not genetic predisposition to a specific disease.

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