Nursing Elites

1. A nurse is reviewing the ABG results of a client with chronic emphysema. Which result suggests the need for further treatment?

• A. PaO2 level of 89 mm Hg
• B. PaCO2 level of 55 mm Hg
• C. HCO3 level of 25 mEq/L
• D. pH level of 7.37

Correct answer: B

Rationale: The correct answer is B. A PaCO2 level of 55 mm Hg is elevated, indicating carbon dioxide retention, a common complication of emphysema that necessitates intervention. Elevated PaCO2 can lead to respiratory acidosis, reflecting inadequate ventilation. Choices A, C, and D are within normal ranges. A PaO2 level of 89 mm Hg is acceptable. An HCO3 level of 25 mEq/L falls within the normal range, suggesting adequate compensation. A pH level of 7.37 is also within the normal range, indicating the client's acid-base balance is maintained.

2. A client with severe preeclampsia is receiving magnesium sulfate intravenously. Which action should the nurse take when toxicity occurs?

• A. Position the client supine
• B. Prepare an IV bolus of dextrose 5%
• C. Administer calcium gluconate IV
• D. Administer methylergonovine IM

Correct answer: C

Rationale: When toxicity from magnesium sulfate occurs, the nurse should administer calcium gluconate IV as it is the antidote for magnesium sulfate toxicity. Positioning the client supine may not address the toxicity issue. Administering dextrose 5% is not the appropriate intervention for magnesium sulfate toxicity. Methylergonovine is used to manage postpartum hemorrhage and is not indicated for magnesium sulfate toxicity.

3. A nurse is providing education to a client about a new prescription for digoxin. Which of the following should be included?

• A. Monitor for increased heart rate
• B. Take the medication at the same time every day
• C. It should be stopped abruptly
• D. Avoid potassium-rich foods

Correct answer: B

Rationale: The correct answer is B: 'Take the medication at the same time every day.' Clients should take digoxin at the same time each day to maintain consistent therapeutic levels, enhancing the drug's effectiveness and minimizing fluctuations in blood concentration. Choice A is incorrect because digoxin, as a medication, may actually help in controlling the heart rate. Choice C is incorrect as digoxin should never be stopped abruptly due to the risk of rebound effects and worsening of the condition. Choice D is unrelated to digoxin therapy, as it is more relevant to medications like potassium-sparing diuretics.

4. A client with a history of renal failure is being cared for by a nurse. Which of the following should the nurse monitor?

• A. Fluid intake
• B. Electrolyte levels
• C. Blood pressure
• D. Both B and C

Correct answer: D

Rationale: Clients with renal failure are at risk for electrolyte imbalances and hypertension. Monitoring electrolyte levels is crucial because renal failure can lead to imbalances in sodium, potassium, and other electrolytes. Blood pressure monitoring is essential as hypertension is a common complication of renal failure. Therefore, both electrolyte levels and blood pressure should be closely monitored to detect and manage any abnormalities. Fluid intake, while important, is not specific to renal failure monitoring and is not the priority in this case.

5. When educating a client about valproic acid, which instruction is essential?

• A. Monitor for rash
• B. Expect weight loss
• C. Consider it safe during pregnancy
• D. Purchase it over-the-counter

Correct answer: A

Rationale: The correct answer is to instruct the client to monitor for rash. Valproic acid can lead to severe skin rashes, and patients must be vigilant to report any rash promptly. Choice B is incorrect as valproic acid is more likely to cause weight gain. Choice C is incorrect because valproic acid is associated with birth defects and should be avoided during pregnancy. Choice D is incorrect as valproic acid is a prescription medication and not available over-the-counter.

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