Nursing Elites

1. A client with liver cirrhosis and severe ascites has a serum sodium level of 115 mEq/L and is receiving 3% saline IV. Which assessment finding indicates that the nurse should notify the healthcare provider?

• A. The client's serum sodium level is now 130 mEq/L
• B. The client reports a headache and has a BP of 140/90
• C. The client reports shortness of breath and has an O2 saturation of 92%
• D. The client has crackles in both lung bases and an increased respiratory rate.

Correct answer: D

Rationale: The presence of crackles in both lung bases and an increased respiratory rate indicates fluid overload, which can be exacerbated by hypertonic saline. This condition can worsen the client's respiratory status and lead to further complications. The other options do not directly relate to the fluid overload caused by the hypertonic saline. A serum sodium level of 130 mEq/L is within a normal range for treatment. A headache and a blood pressure of 140/90 are not specific indicators of worsening condition related to hypertonic saline. Shortness of breath and an O2 saturation of 92% could be related to other factors in a client with liver cirrhosis and ascites.

2. A client who had a gestational trophoblastic disease (GTD) evacuated 2 days ago is being monitored for choriocarcinoma. She lives in a rural area, and her husband takes the family car to work daily, leaving her without transportation during the day. What intervention is most important for the nurse to implement?

• A. Teach the client about the use of a home pregnancy test.
• B. Schedule a weekly home visit to draw hCG values.
• C. Make a 5-week follow-up appointment with the healthcare provider.
• D. Begin chemotherapy administration during the first home visit.

Correct answer: B

Rationale: Scheduling weekly home visits to monitor hCG levels is critical for early detection of choriocarcinoma, a potential complication of GTD. Choice A is incorrect because a home pregnancy test is not the appropriate method to monitor for choriocarcinoma. Choice C is less frequent than necessary for close monitoring. Choice D is incorrect as chemotherapy administration should be based on confirmed diagnosis and treatment plan, not initiated during the first home visit.

3. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which intervention should the nurse implement first?

• A. Administer oxygen therapy as prescribed.
• B. Elevate the head of the bed.
• C. Obtain a sputum culture.
• D. Administer antibiotics as prescribed.

Correct answer: A

Rationale: The correct answer is to administer oxygen therapy as prescribed. In COPD exacerbation, the priority is to improve oxygenation. Administering oxygen therapy helps ensure an adequate oxygen supply to the body's tissues. Elevating the head of the bed can improve ventilation but is not the first intervention needed in this situation. Obtaining a sputum culture and administering antibiotics are important in COPD exacerbation but come after ensuring proper oxygenation.

4. A male client with impaired renal function who takes ibuprofen daily for chronic arthritis is admitted with gastrointestinal (GI) bleeding. After administering IV fluids and a blood transfusion, his blood pressure is 100/70, and his renal output is 20 ml/hour. Which intervention should the nurse include in care?

• A. Maintain the client NPO during the diuresis phase.
• B. Evaluate daily serial renal laboratory studies for progressive elevations.
• C. Observe the urine character for sedimentation and cloudy appearance.
• D. Monitor for onset of polyuria greater than 150ml/hour.

Correct answer: B

Rationale: Evaluating daily renal laboratory studies is crucial in this scenario. The client has impaired renal function, recent GI bleeding, and is at risk for further kidney damage due to ibuprofen use. Monitoring renal labs helps assess kidney function and detect any progressive elevations, guiding further interventions. Option A is not directly related to renal function monitoring. Option C focuses more on urine appearance than renal function assessment. Option D mentions polyuria, which is excessive urine output, but the question describes a client with reduced renal output.

5. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which laboratory value is most concerning?

• A. Serum sodium of 135 mEq/L
• B. Serum potassium of 4.0 mEq/L
• C. Serum bicarbonate of 18 mEq/L
• D. Serum glucose of 300 mg/dL

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L is most concerning in a client with COPD as it indicates metabolic acidosis, requiring immediate intervention. In COPD, patients often retain carbon dioxide, leading to respiratory acidosis. A low serum bicarbonate level suggests that the body is compensating for this respiratory acidosis by increasing bicarbonate levels to maintain balance. Therefore, a low serum bicarbonate level in this scenario is alarming. Choices A, B, and D are within normal ranges and not directly related to the acid-base imbalance seen in COPD.

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