Nursing Elites

1. A client with chronic kidney disease is receiving epoetin alfa. Which laboratory value should the nurse monitor to determine the effectiveness of the treatment?

• A. Blood urea nitrogen (BUN)
• B. Serum creatinine
• C. Hemoglobin and hematocrit
• D. Serum potassium

Correct answer: C

Rationale: The correct answer is C: Hemoglobin and hematocrit. Epoetin alfa is a medication that stimulates red blood cell production, so monitoring hemoglobin and hematocrit levels is essential to assess its effectiveness. These values reflect the oxygen-carrying capacity of the blood and can indicate if the treatment is improving anemia related to chronic kidney disease. Choices A, B, and D are incorrect. Blood urea nitrogen (BUN) and serum creatinine are indicators of kidney function, while serum potassium levels are monitored due to electrolyte imbalances commonly seen in kidney disease, but they do not directly reflect the effectiveness of epoetin alfa.

2. The nurse is providing postoperative care for a client who had a thyroidectomy. Which assessment finding requires immediate intervention?

• A. Hoarseness and weak voice
• B. Calcium level of 8.0 mg/dL (2.0 mmol/L)
• C. Heart rate of 110 beats per minute
• D. Difficulty swallowing

Correct answer: D

Rationale: Difficulty swallowing can indicate swelling or hematoma formation, which may compromise the airway and requires immediate intervention. Hoarseness and a weak voice are expected post-thyroidectomy due to manipulation of the laryngeal nerves but do not require immediate intervention. A calcium level of 8.0 mg/dL is within the normal range (8.5-10.5 mg/dL) and may not require immediate intervention. A heart rate of 110 beats per minute may be elevated due to stress or pain postoperatively, but it does not indicate an immediate threat to the airway.

3. A client with rheumatoid arthritis has elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

• A. Evidence of spread of the disease to the kidney.
• B. Confirmation of the autoimmune disease process.
• C. Representative of a decline in the client's condition.
• D. Indication of the onset of joint degeneration.

Correct answer: B

Rationale: The correct interpretation of elevated serum rheumatoid factor in a client with rheumatoid arthritis is confirmation of the autoimmune disease process. Rheumatoid factor is a marker for autoimmune activity, thus confirming the diagnosis of rheumatoid arthritis. Choice A is incorrect as elevated rheumatoid factor does not specifically indicate spread of the disease to the kidney. Choice C is incorrect as elevated rheumatoid factor does not always represent a decline in the client's condition. Choice D is incorrect as elevated rheumatoid factor is not an indication of the onset of joint degeneration, but rather points towards autoimmune activity.

4. A client with peptic ulcer disease is prescribed sucralfate. What is the mechanism of action of this medication?

• A. Neutralizes stomach acid
• B. Decreases gastric acid secretion
• C. Covers the ulcer site and protects it from acid
• D. Improves gastric motility

Correct answer: C

Rationale: The correct answer is C: Covers the ulcer site and protects it from acid. Sucralfate works by forming a protective barrier over ulcers, shielding them from stomach acid and promoting healing. Choice A, neutralizing stomach acid, is incorrect as sucralfate does not neutralize acid but acts as a physical barrier. Choice B, decreasing gastric acid secretion, is not the mechanism of action of sucralfate. Choice D, improving gastric motility, is unrelated to sucralfate's action on peptic ulcers.

5. What pathophysiologic process is producing the symptoms of gout in a client with sudden onset of big toe joint pain and swelling?

• A. Deposition of crystals in the synovial space of the joints produces inflammation and irritation.
• B. Degeneration of joint cartilage causing inflammation.
• C. Infection of the joint space leading to inflammation.
• D. Increased synovial fluid causing joint swelling and pain.

Correct answer: A

Rationale: The correct answer is A. Gout is characterized by the deposition of uric acid crystals in the synovial fluid of joints, which triggers inflammation and pain. This process is known as crystal-induced arthritis. Choice B is incorrect as gout does not involve degeneration of joint cartilage. Choice C is incorrect as gout is not caused by an infection of the joint space. Choice D is incorrect as gout does not result from increased synovial fluid but rather from the deposition of uric acid crystals.

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