Nursing Elites

1. A client presents with a urine specific gravity of 1.018. What action should the nurse take?

• A. Evaluate the client’s intake and output for the past 24 hours.
• B. Document the finding in the chart and continue to monitor.
• C. Obtain a specimen for a urine culture and sensitivity.
• D. Encourage the client to drink more fluids, especially water.

Correct answer: B

Rationale: A urine specific gravity of 1.018 falls within the normal range, indicating adequate hydration. Therefore, the appropriate action is to document this finding in the client's chart and continue monitoring. There is no need to evaluate intake and output, as the specific gravity is normal. Obtaining a urine culture and sensitivity or encouraging increased fluid intake is unnecessary in this situation.

2. The client is being educated by the nurse on home blood glucose monitoring. Which of the following blood glucose measurements indicates hypoglycemia?

• A. 59 mg/dL (3.3 mmol/L)
• B. 75 mg/dL (4.2 mmol/L)
• C. 108 mg/dL (6 mmol/L)
• D. 119 mg/dL (6.6 mmol/L)

Correct answer: A

Rationale: A blood glucose level of 59 mg/dL (3.3 mmol/L) is considered hypoglycemia, which is an abnormally low blood sugar level. This level requires immediate attention as it can lead to symptoms such as confusion, shakiness, and even loss of consciousness if left untreated. Choices B, C, and D have blood glucose levels within the normal range or slightly higher, indicating euglycemia or normal blood sugar levels, and not hypoglycemia.

3. A client with chronic kidney disease missed dialysis yesterday to attend a funeral. The client's wife calls the home health nurse and reports that her husband is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?

• A. Apply the client's home oxygen.
• B. Check for a thrill and bruit at the client's dialysis access site.
• C. Ensure the client avoids salt intake for the rest of the day.
• D. Take the client to the emergency department (ED).

Correct answer: D

Rationale: In this scenario, the most crucial instruction for the nurse to provide is to take the client to the emergency department (ED). Missing dialysis can lead to severe complications in clients with chronic kidney disease, such as electrolyte imbalances and fluid overload. Lethargy and difficulty in arousing the client suggest a critical situation that requires immediate medical attention. Applying home oxygen, checking the dialysis access site, and ensuring salt intake avoidance, although important, are not as urgent as seeking emergency care to address the potential severe complications from missed dialysis.

4. A nurse reviews laboratory results for a client with glomerulonephritis. The client’s glomerular filtration rate (GFR) is 40 mL/min as measured by a 24-hour creatinine clearance. How should the nurse interpret this finding? (Select all that apply.)

• A. Excessive GFR
• B. Reduced GFR
• C. Fluid retention and risks for hypertension
• D. Pulmonary edema

Correct answer: B

Rationale: A GFR of 40 mL/min indicates a reduced glomerular filtration rate. In a healthy adult, the normal GFR ranges between 100 and 120 mL/min. A GFR of 40 mL/min signifies a significant reduction, leading to fluid retention and risks for hypertension and pulmonary edema due to excess vascular fluid. Choices A, C, and D are incorrect. Choice A is incorrect as a GFR of 40 mL/min is not excessive but rather reduced. Choices C and D do not directly address the interpretation of GFR but instead describe potential consequences of a reduced GFR.

5. A client who is anxious about an impending surgery is at risk for respiratory alkalosis. For which signs and symptoms of respiratory alkalosis does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: C

Rationale: The correct answer is C: Tachypnea, dizziness, and paresthesias. When a client is anxious, they may hyperventilate, leading to respiratory alkalosis. Tachypnea (rapid breathing) is a common sign of respiratory alkalosis. Dizziness and paresthesias (tingling or numbness in the extremities) are also typical symptoms. Choices A, B, and D are incorrect. Disorientation and dyspnea (Choice A) are not specific signs of respiratory alkalosis. Drowsiness, headache, and tachypnea (Choice B) may be more indicative of other conditions. Dysrhythmias and decreased respiratory rate and depth (Choice D) are not consistent with the expected signs of respiratory alkalosis.

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