Nursing Elites

1. When caring for a client with acute renal failure, which laboratory value is most important to monitor?

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

Correct answer: B

Rationale: In acute renal failure, monitoring serum potassium is crucial because impaired kidney function can lead to hyperkalemia, which can result in life-threatening cardiac dysrhythmias. Elevated potassium levels need close monitoring and prompt interventions to prevent serious complications.

2. A patient is assessing a client who has just been admitted to the emergency department. The client is having difficulty breathing and is using accessory muscles. What action by the nurse is best?

• A. Administer oxygen at 2 liters per minute via nasal cannula.
• B. Assess the client's vital signs including oxygen saturation.
• C. Notify the Rapid Response Team immediately.
• D. Place the client in a high Fowler's position.

Correct answer: D

Rationale: Placing the client in a high Fowler's position is the best action in this situation as it helps to maximize lung expansion, improve breathing, and decrease the work of breathing. This position allows for better chest expansion, improving oxygenation and ventilation for the client in respiratory distress.

3. A client has a disposable three-chamber chest tube in place. Which of the following findings should indicate to the nurse that the client is experiencing a complication?

• A. Continuous bubbling in the water-seal chamber
• B. Occasional bubbling in the water-seal chamber
• C. Constant bubbling in the suction-control chamber
• D. Fluctuations in the fluid level in the water-seal chamber

Correct answer: A

Rationale: Continuous bubbling in the water-seal chamber indicates air is leaking into the pleural space, which is a complication. The water-seal chamber should have intermittent bubbling during normal functioning. Occasional bubbling in the water-seal chamber is normal and shows the system is working as intended. Constant bubbling in the suction-control chamber suggests an issue with the suction control. Fluctuations in the fluid level in the water-seal chamber are an expected finding.

4. A client with heart failure expresses feelings of burden and thoughts of death to a nurse. How should the nurse respond?

• A. Would you like to talk more about this?
• B. You are lucky to have such a devoted daughter.
• C. It is normal to feel as though you are a burden.
• D. Would you like to meet with the chaplain?

Correct answer: A

Rationale: Depression can occur in clients with heart failure, especially in older adults. When a client expresses thoughts of being a burden and death, it is crucial for the nurse to address these concerns. Offering to talk more about the client's feelings provides an opportunity for open communication and a deeper understanding of the client's emotions. Open-ended questions like the one in choice A encourage the client to express themselves freely, leading to better assessment and client-centered care. Choices B and C fail to address the client's emotional distress directly, and choice D diverts the focus without addressing the client's immediate concerns.

5. A client with chronic obstructive pulmonary disease (COPD) appears thin and disheveled. Which question should the nurse ask first?

• A. Do you have a strong support system?
• B. What do you understand about your disease?
• C. Do you experience shortness of breath with basic activities?
• D. What medications are you prescribed to take each day?

Correct answer: C

Rationale: In clients with severe COPD, shortness of breath can significantly impact their ability to perform basic activities like bathing and eating. Therefore, the nurse's priority should be to assess if shortness of breath is interfering with the client's basic activities, which can provide crucial information for planning and managing care.

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