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. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take this medication with food and plenty of water.
• B. I shall keep my appointment at the infusion center each week.
• C. I’ll limit my intake of green leafy vegetables while on this medication.
• D. I must not take this medication if I have an infection or am feeling ill.

Correct answer: B

Rationale: The correct answer is B. Temsirolimus, also known as Torisel, is administered as a weekly intravenous infusion. This medication blocks protein needed for cell division, inhibiting cell cycle progression. It is not taken orally, so there is no need to take it with food or water. Keeping the weekly infusion center appointment is crucial for the client to receive the prescribed treatment effectively. Choice A is incorrect as temsirolimus is not taken with food or water. Choice C is incorrect because there is no need to limit the intake of green leafy vegetables while on this medication. Choice D is incorrect as having an infection or feeling ill does not prohibit the use of temsirolimus.

3. In a patient with deep vein thrombosis (DVT), which of the following symptoms would be expected?

• A. Chest pain.
• B. Shortness of breath.
• C. Coughing up blood.
• D. Cyanosis.

Correct answer: B

Rationale: Shortness of breath is a common symptom of deep vein thrombosis (DVT) due to the risk of a pulmonary embolism. DVT occurs when a blood clot forms in a deep vein, usually in the legs. If a portion of the clot breaks loose and travels to the lungs, it can cause a pulmonary embolism, leading to symptoms like shortness of breath. Chest pain is more commonly associated with conditions like a heart attack or pulmonary embolism itself. Coughing up blood is a symptom more indicative of conditions such as pulmonary embolism or lung cancer. Cyanosis, which is a bluish discoloration of the skin or mucous membranes due to poor oxygenation, can be seen in severe cases of pulmonary embolism but is not a typical symptom of DVT.

4. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patient’s electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL per hour. Which action is necessary prior to administering this fluid?

• A. Evaluate the patient’s urine output.
• B. Contact the provider to order arterial blood gases.
• C. Request an order for an initial potassium bolus.
• D. Suggest a diet low in sodium and potassium.

Correct answer: A

Rationale: Prior to administering IV fluids containing potassium, it is crucial to evaluate the patient's urine output. If the urine output is less than 25 mL/hr or 600 mL/day, there is a risk of potassium accumulation. Patients with low urine output should not receive IV potassium to prevent potential complications. Contacting the provider for arterial blood gases is unnecessary in this scenario as it does not directly relate to the administration of IV fluids with potassium. Administering potassium as a bolus is not recommended due to potential adverse effects. While dietary considerations are important, suggesting a low-sodium and low-potassium diet is not the immediate action required before administering IV fluids with potassium chloride.

5. In a patient with liver cirrhosis, which of the following lab results would be expected?

• A. Increased bilirubin levels.
• B. Decreased albumin levels.
• C. Increased liver enzymes.
• D. Decreased platelet count.

Correct answer: A

Rationale: In a patient with liver cirrhosis, increased bilirubin levels would be expected. Liver cirrhosis leads to impaired liver function, causing a decrease in the liver's ability to process bilirubin, leading to its accumulation in the blood. This results in elevated bilirubin levels. Decreased albumin levels (choice B) may occur in liver cirrhosis due to impaired liver synthesis of proteins, but it is not as specific as increased bilirubin levels. Increased liver enzymes (choice C) can be seen in liver damage but are not as characteristic as elevated bilirubin levels. Decreased platelet count (choice D) can occur in liver cirrhosis due to hypersplenism, but it is not as specific as increased bilirubin levels in this context.

Similar Questions