Nursing Elites

1. A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?

• A. Check the client’s digoxin (Lanoxin) level.
• B. Administer an anti-nausea medication.
• C. Ask if the client can eat crackers.
• D. Refer the client to a gastrointestinal specialist.

Correct answer: A

Rationale: In a client with chronic kidney disease experiencing symptoms like nausea, vomiting, visual changes, and anorexia, it is crucial for the nurse to suspect digoxin (Lanoxin) toxicity. These symptoms are indicative of digoxin toxicity. Therefore, the best action for the nurse to take is to check the client's digoxin level. Administering anti-nausea medication, asking about eating crackers, and referring to a gastrointestinal specialist may help with symptom management but do not address the underlying cause of the symptoms, which is digoxin toxicity in this case.

2. The nurse is caring for a client with chronic renal failure who is receiving peritoneal dialysis. Which of the following findings should be reported immediately to the physician?

• A. Clear dialysate outflow.
• B. Increased blood pressure.
• C. Cloudy dialysate outflow.
• D. Decreased urine output.

Correct answer: C

Rationale: Cloudy dialysate outflow should be reported immediately to the physician. It is indicative of peritonitis, a severe infection of the peritoneal cavity and a serious complication of peritoneal dialysis. Prompt medical attention is crucial to prevent further complications or systemic infection. Clear dialysate outflow (Choice A) is a normal finding in peritoneal dialysis. Increased blood pressure (Choice B) and decreased urine output (Choice D) are common in clients with chronic renal failure and may not require immediate reporting unless they are significantly abnormal or accompanied by other concerning symptoms.

3. A client expresses difficulty voiding in public places. How should the nurse respond?

• A. Offer to turn on the faucet in the bathroom to help stimulate urination.
• B. Suggest a prescription for a diuretic to increase urine output.
• C. Propose moving to a room with a private bathroom to enhance comfort.
• D. Close the curtain to provide maximum privacy.

Correct answer: D

Rationale: The nurse should prioritize the client's privacy when addressing issues related to voiding discomfort in public places. Closing the curtain in the current room would offer immediate privacy and support the client's needs. Turning on the faucet is not an evidence-based intervention for voiding difficulties. Prescribing a diuretic is not appropriate without further assessment. While moving to a room with a private bathroom might be ideal, it may not be immediately feasible, making ensuring privacy in the current setting the most appropriate action.

4. A client with a history of lung disease is at risk for respiratory acidosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: A

Rationale: The correct answer is A: Disorientation and dyspnea. In respiratory acidosis, the retention of carbon dioxide leads to an increase in carbonic acid, causing the pH of the blood to decrease. This can result in symptoms such as dyspnea (difficulty breathing) due to hypoxia and disorientation due to the effects of hypercapnia (elevated carbon dioxide levels) on the brain. Choice B is incorrect because while drowsiness and tachypnea can be present in respiratory acidosis, headache is not a common symptom. Choice C is incorrect because dizziness and paresthesias are not typical symptoms of respiratory acidosis. Choice D is incorrect because dysrhythmias and a decreased respiratory rate and depth are more commonly associated with respiratory alkalosis, not respiratory acidosis.

5. Which of the following interventions is most appropriate for a patient with left-sided heart failure?

• A. Administering IV fluids.
• B. Administering oxygen.
• C. Administering diuretics.
• D. Administering antihypertensives.

Correct answer: B

Rationale: Administering oxygen is the most appropriate intervention for a patient with left-sided heart failure because it helps improve oxygenation. In left-sided heart failure, the heart struggles to pump oxygen-rich blood to the body, leading to inadequate oxygen supply to tissues. Administering oxygen can help alleviate symptoms of hypoxia and reduce the workload on the heart. IV fluids (Choice A) may exacerbate heart failure by increasing fluid volume, diuretics (Choice C) are used to reduce fluid overload in heart failure, and antihypertensives (Choice D) are more suitable for managing hypertension, which may be a comorbidity in heart failure but are not the primary intervention for left-sided heart failure.

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