Nursing Elites

1. A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is receiving 3% sodium chloride via continuous IV. Which of the following laboratory findings should the nurse identify as an indication that the SIADH is resolving?

• A. Urine specific gravity 1.020
• B. Sodium 119 mEq/L
• C. BUN 8 mg/dL
• D. Calcium 8.7 mg/dL

Correct answer: A

Rationale: A urine specific gravity of 1.020 is within the expected reference range and indicates that the kidneys are appropriately concentrating urine, which is a sign that the syndrome of inappropriate antidiuretic hormone (SIADH) is resolving. A low sodium level (choice B) is associated with SIADH, so a sodium level of 119 mEq/L is not indicative of resolution. BUN (choice C) and calcium levels (choice D) are typically not directly related to SIADH resolution.

2. A nurse is providing teaching to a client who was newly diagnosed with nephrotic syndrome. Which of the following statements should indicate to the nurse that the client understands the teaching?

• A. I can expect swelling in my hands and on my face.
• B. The amount of protein in my blood is high.
• C. I might have some pain and gas in my stomach from this condition.
• D. I will use a soft bristle toothbrush to prevent bleeding gums.

Correct answer: A

Rationale: The correct answer is A. Nephrotic syndrome leads to edema, especially of the face and dependent areas, due to the loss of protein in the urine. Choice B is incorrect because nephrotic syndrome leads to protein loss in the urine, not an increase in blood protein levels. Choice C is incorrect as stomach pain and gas are not typical symptoms of nephrotic syndrome. Choice D is incorrect as using a soft bristle toothbrush is not directly related to the manifestations of nephrotic syndrome.

3. What is the priority dietary modification for a patient with pre-dialysis end-stage kidney disease?

• A. Limit phosphorus intake to 700 mg/day
• B. Increase potassium intake to 3 g/day
• C. Eat three large meals per day
• D. Restrict protein intake to 1 g/kg/day

Correct answer: A

Rationale: The correct answer is A: Limit phosphorus intake to 700 mg/day. In patients with pre-dialysis end-stage kidney disease, restricting phosphorus intake is crucial to manage their condition. Excessive phosphorus can lead to mineral and bone disorders, which are common in kidney disease. Choice B, increasing potassium intake, is not the priority and can be harmful as kidney disease often leads to hyperkalemia. Choice C, eating three large meals per day, is not recommended as smaller, frequent meals are usually better tolerated. Choice D, restricting protein intake to 1 g/kg/day, is important in later stages of kidney disease but is not the priority at the pre-dialysis stage.

4. A client is to undergo a liver biopsy. Which of the following instructions should the nurse provide to the client following the procedure?

• A. Lie on your left side.
• B. Lie on your right side.
• C. Increase your fluid intake.
• D. Decrease your fluid intake.

Correct answer: B

Rationale: After a liver biopsy, the nurse should instruct the client to lie on the right side. This position helps apply pressure to the biopsy site, promoting hemostasis and reducing the risk of bleeding. Lying on the left side may not provide adequate pressure to the site. Increasing fluid intake is generally beneficial to prevent dehydration and aid in the recovery process, whereas decreasing fluid intake could lead to dehydration and possible complications. Therefore, the correct instruction is to lie on the right side.

5. What are the expected findings in a patient experiencing hypokalemia?

• A. Flattened T waves on an ECG
• B. Elevated ST segments
• C. Prominent U waves
• D. Bradycardia

Correct answer: A

Rationale: The correct answer is A: Flattened T waves on an ECG. Hypokalemia is characterized by flattened T waves on an ECG, which is an early indicator of low potassium levels. Elevated ST segments (Choice B) are associated with conditions like myocardial infarction, not hypokalemia. Prominent U waves (Choice C) are typically seen in hypokalemia, but flattened T waves are more specific. Bradycardia (Choice D) can be a manifestation of severe hypokalemia but is not as specific as flattened T waves on an ECG.

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