Nursing Elites

1. A client with renal insufficiency and a low red blood cell count asks, 'Is my anemia related to the renal insufficiency?' How should the nurse respond?

• A. Red blood cells produce erythropoietin, which increases blood flow to the kidneys.
• B. Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.
• C. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.
• D. Kidney insufficiency inhibits active transportation of red blood cells throughout the blood.

Correct answer: C

Rationale: The correct answer is C. Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia in renal insufficiency is often due to decreased erythropoietin production. Anemia and renal insufficiency are not manifestations of vitamin D deficiency as stated in choice B. Choice A is incorrect as erythropoietin does not increase blood flow to the kidneys. Choice D is incorrect because kidney insufficiency does not inhibit active transportation of red blood cells throughout the blood; rather, it affects erythropoietin production and subsequent red blood cell formation.

2. When planning activities for a socialization group for older residents of a long-term facility, what information would be most useful for the nurse?

• A. The length of time each resident has resided at the facility.
• B. A brief description of each resident's family life.
• C. The age of each resident.
• D. The usual activity patterns of each resident.

Correct answer: D

Rationale: The most useful information for the nurse when planning activities for a socialization group for older residents of a long-term facility would be the usual activity patterns of each resident. An older person's level of activity is a determining factor in adjustment to aging, as described by the Activity Theory of Aging. By understanding the usual activity patterns of each resident, the nurse can tailor activities that cater to their interests and abilities, promoting social engagement and overall well-being. The other options, such as the length of time residing at the facility, a brief description of family life, or the age of each resident, may provide some insights but do not directly relate to planning activities that support adjustment to aging and socialization within the group.

3. A client with chronic kidney disease starts on hemodialysis. During the first dialysis treatment, the client's blood pressure drops from 150/90 to 80/30. Which action should the nurse take first?

• A. Stop the dialysis treatment
• B. Administer 5% albumin IV
• C. Monitor blood pressure every 45 minutes
• D. Lower the head of the chair and elevate feet

Correct answer: D

Rationale: The initial action the nurse should take when a client's blood pressure drops significantly during hemodialysis is to lower the head of the chair and elevate the feet. This position adjustment helps improve blood flow to the brain and vital organs, assisting in stabilizing blood pressure. Stopping the dialysis treatment immediately may not be necessary if the blood pressure can be managed effectively by position changes. Administering 5% albumin IV is not the first-line intervention for hypotension during dialysis. Monitoring blood pressure every 45 minutes is important but not the immediate action needed to address the significant drop in blood pressure observed during the dialysis session.

4. A nurse is teaching a nursing student how to measure a carotid pulse. The nurse should tell the student to measure the pulse on only one side of the client’s neck primarily because:

• A. It is unnecessary to use both hands
• B. Feeling dual pulsations may lead to an incorrect measurement
• C. Palpating both carotid pulses simultaneously could occlude the trachea
• D. Palpating both carotid pulses simultaneously could cause the heart rate and blood pressure to drop

Correct answer: D

Rationale: The correct answer is D. Applying pressure to both carotid arteries at the same time is contraindicated. Excess pressure to the baroreceptors in the carotid vessels could cause the heart rate and blood pressure to reflexively drop. Palpating both carotid pulses simultaneously could also interfere with the flow of blood to the brain, possibly causing dizziness and syncope. Choices A, B, and C are incorrect. It is necessary to use both hands to measure the carotid pulse accurately. Feeling dual pulsations does not lead to an incorrect measurement, and palpating both carotid pulses simultaneously does not occlude the trachea.

5. What is the priority assessment for a patient receiving intravenous morphine?

• A. Assessing the patient's blood pressure.
• B. Monitoring the patient's respiratory rate.
• C. Checking the patient's pain level.
• D. Monitoring the patient's oxygen saturation.

Correct answer: B

Rationale: The correct answer is monitoring the patient's respiratory rate. When a patient receives intravenous morphine, the priority assessment is to monitor the respiratory rate due to the risk of respiratory depression associated with morphine. This assessment helps in detecting and managing any potential respiratory complications promptly. Assessing blood pressure, checking pain level, and monitoring oxygen saturation are important aspects of patient care but are not the priority when considering the specific risk of respiratory depression with intravenous morphine.

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