Nursing Elites

1. A nurse is caring for a client who has chronic kidney disease. The nurse should identify which of the following laboratory values as an indication for hemodialysis?

• A. Glomerular filtration rate of 14 mL/min
• B. BUN 16 mg/dL
• C. Serum magnesium 1.8 mg/dL
• D. Serum phosphorus 4.0 mg/dL

Correct answer: A

Rationale: A glomerular filtration rate (GFR) of 14 mL/min is significantly low, indicating poor kidney function and the need for hemodialysis to remove waste products effectively. BUN, serum magnesium, and serum phosphorus levels are important in assessing kidney function and electrolyte balance but are not direct indicators for the initiation of hemodialysis. BUN (blood urea nitrogen) reflects the kidney's ability to filter waste products, serum magnesium levels are important for muscle and nerve function, and serum phosphorus levels are vital for bone health.

2. What is the most appropriate intervention for a patient with a suspected stroke?

• A. Administer IV fluids
• B. Perform a CT scan
• C. Perform a lumbar puncture
• D. Administer anticoagulants

Correct answer: B

Rationale: The most appropriate intervention for a patient with a suspected stroke is to perform a CT scan. A CT scan is crucial for diagnosing a stroke by visualizing any bleeding or blockages in the brain. Administering IV fluids (Choice A) may be necessary based on the patient's condition, but it is not the primary intervention for a suspected stroke. Performing a lumbar puncture (Choice C) is not indicated for stroke evaluation and may not provide relevant information. Administering anticoagulants (Choice D) is a treatment option for certain types of strokes but should be based on the CT scan results and specific guidelines.

3. A nurse is caring for a client who has a new prescription for spironolactone. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the medication?

• A. Serum sodium.
• B. Serum calcium.
• C. Serum potassium.
• D. Serum glucose.

Correct answer: C

Rationale: Corrected Rationale: Spironolactone is a potassium-sparing diuretic, so serum potassium should be monitored to evaluate its effectiveness. Monitoring serum potassium levels is crucial because spironolactone can cause hyperkalemia as a side effect. Serum sodium, serum calcium, and serum glucose levels are not directly affected by spironolactone and would not provide an accurate assessment of the medication's effectiveness.

4. A nurse is assessing a client who has a new prescription for enoxaparin. Which of the following findings is a priority for the nurse to report?

• A. Platelet count of 200,000/mm³
• B. Hemoglobin level of 15 g/dL
• C. Respiratory rate of 22/min
• D. Dark, tarry stools

Correct answer: D

Rationale: The correct answer is D. Dark, tarry stools indicate gastrointestinal bleeding, which is a serious side effect of enoxaparin that requires immediate medical attention. Reporting this finding promptly is crucial to prevent further complications. Choices A, B, and C are within normal ranges and are not directly related to the adverse effects of enoxaparin, so they do not take precedence over the urgent concern of gastrointestinal bleeding.

5. A nurse is performing a dressing change for a client who has a sacral wound using negative pressure wound therapy. Which of the following actions should the nurse take first?

• A. Apply skin preparation to wound edges.
• B. Don sterile gloves.
• C. Normal saline
• D. Determine pain level.

Correct answer: D

Rationale: The correct answer is to determine the pain level first. Assessing the client's pain is crucial before any procedure to ensure their comfort and safety. Applying skin preparation to wound edges (Choice A) may come later in the process after ensuring the client's comfort. Donning sterile gloves (Choice B) is important before directly handling the wound but can follow pain assessment. Normal saline (Choice C) might be used during wound cleansing but is not the initial step in this situation.

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