Nursing Elites

1. A client with chronic kidney disease is prescribed a low-protein diet. Which laboratory result should the nurse monitor to evaluate the effectiveness of the diet?

• A. Blood urea nitrogen (BUN)
• B. Serum potassium
• C. Serum calcium
• D. Creatinine clearance

Correct answer: A

Rationale: Blood urea nitrogen (BUN) levels should be monitored to assess the effectiveness of a low-protein diet in clients with chronic kidney disease. BUN levels reflect the breakdown of protein in the body, and a low-protein diet aims to reduce BUN levels to lessen the workload on the kidneys. Therefore, monitoring BUN levels is crucial in managing kidney function and evaluating the impact of dietary modifications. Serum potassium, serum calcium, and creatinine clearance are important parameters to monitor in clients with chronic kidney disease, but they are not specifically indicative of the effectiveness of a low-protein diet. Serum potassium levels are crucial in assessing electrolyte balance, serum calcium levels are important for bone health and nerve function, and creatinine clearance reflects kidney function overall, not just the impact of a low-protein diet.

2. What is the primary action of a short-acting beta2-agonist (SABA) prescribed to a patient with an acute asthma exacerbation?

• A. Reduce inflammation
• B. Relieve bronchospasm
• C. Thin respiratory secretions
• D. Suppress cough

Correct answer: B

Rationale: The correct answer is B: Relieve bronchospasm. The primary action of short-acting beta2-agonists (SABAs) is to relieve bronchospasm. These medications are bronchodilators that work by opening the airways, making breathing easier for patients experiencing asthma exacerbations. By relieving bronchospasm, SABAs help improve airflow and alleviate symptoms of asthma such as wheezing and shortness of breath. Choices A, C, and D are incorrect because SABAs do not primarily reduce inflammation, thin respiratory secretions, or suppress cough. While these actions may be part of asthma management, the immediate goal of using a SABA during an acute exacerbation is to quickly relieve bronchospasm and improve airflow.

3. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective?

• A. The client's extremities are paralyzed.
• B. The peripheral nerve stimulator causes twitching.
• C. The client clenches fist upon command.
• D. The client's Glasgow Coma Scale score is 14.

Correct answer: A

Rationale: The correct answer is A. Tubocurarine chloride is a neuromuscular blocker that works by causing paralysis of skeletal muscles. Therefore, if the client's extremities are paralyzed, it indicates that the medication is effective in achieving the desired muscle relaxation necessary for mechanical ventilation. Choices B and C are incorrect as they suggest muscle activity, which would not be expected with the administration of a neuromuscular blocker. Choice D is unrelated to the effectiveness of tubocurarine chloride.

4. A 38-year-old male client collapsed at his outside construction job in Texas in July. His admitting vital signs to ICU are, BP 82/70, heart rate 140 beats/minute, urine output 10 ml/hr, skin cool to the touch. Pulmonary artery (PA) pressures are, PAWP 1, PAP 8/2, RAP -1, SVR 1600. What nursing action has the highest priority?

• A. Apply a hypothermia unit to stabilize core temperature.
• B. Increase the client's IV fluid rate to 200 ml/hr.
• C. Call the hospital chaplain to counsel the family.
• D. Draw blood cultures x3 to detect infection.

Correct answer: B

Rationale: The correct answer is to increase the client's IV fluid rate to 200 ml/hr. The client's vital signs indicate signs of shock and hypovolemia, making fluid resuscitation the priority to address these conditions. Improving intravascular volume is crucial to stabilize the client's blood pressure, heart rate, and urine output, ultimately improving organ perfusion and addressing the underlying issue of hypovolemia.

5. A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?

• A. I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.
• B. It's hard to believe that there are actually medications that can treat obesity.
• C. I'm a bit nervous to start this medication because I know I'll need blood tests sometimes.
• D. I'm going to have to do some rearranging of my finances to make sure I can afford this medication.

Correct answer: A

Rationale: Choice A suggests the need for further health education as the client expresses a reluctance to exercise or change dietary habits, indicating a lack of understanding about the importance of lifestyle modifications in conjunction with medication for effective weight management. It is important for the client to comprehend that a holistic approach, including lifestyle changes, is crucial for successful obesity treatment and long-term health benefits.

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