Nursing Elites

1. When a patient is receiving high doses of a cephalosporin, which laboratory values will this patient's nurse monitor closely?

• A. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
• B. Complete blood count and electrolytes
• C. Serum calcium and magnesium
• D. Serum glucose and lipids

Correct answer: A

Rationale: When a patient is receiving high doses of a cephalosporin, such as cefazolin, the nurse should closely monitor laboratory values that indicate renal and hepatic function. This includes checking the Blood Urea Nitrogen (BUN) and serum creatinine levels to assess kidney function. Additionally, monitoring liver function tests, such as AST, ALT, ALP, LDH, and bilirubin, is essential as cephalosporins can affect liver enzymes. Therefore, options B, C, and D are incorrect as they do not specifically address the parameters that are most pertinent when administering high doses of cephalosporins.

2. A nurse cares for a client with urinary incontinence. The client states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How should the nurse respond?

• A. I understand how you feel. I would be mortified.
• B. Incontinence pads will minimize leaks in public.
• C. I can teach you strategies to help control your incontinence.
• D. More women experience incontinence than you might think.

Correct answer: C

Rationale: The nurse should accept and acknowledge the client’s concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client’s concerns with the use of pads or stating statistics about the occurrence of incontinence.

3. The client with chronic renal failure is being taught about the importance of fluid restrictions. Which of the following statements by the client indicates that the teaching has been effective?

• A. I can drink as much fluid as I want, as long as I take my medication.
• B. I will need to limit my fluid intake to prevent fluid overload.
• C. I can drink as much water as I want, as long as I limit other fluids.
• D. I will need to drink only when I am thirsty.

Correct answer: B

Rationale: The correct answer is B: 'I will need to limit my fluid intake to prevent fluid overload.' In chronic renal failure, fluid restrictions are crucial to prevent fluid overload and further damage to the kidneys. Option A is incorrect as unrestricted fluid intake can worsen the condition. Option C is also incorrect as total fluid intake needs to be restricted, not just other fluids. Option D is not ideal because thirst may not accurately reflect the body's fluid needs in chronic renal failure.

4. In a patient with cirrhosis, which of the following lab results is most concerning?

• A. Elevated liver enzymes.
• B. Low albumin levels.
• C. Elevated bilirubin levels.
• D. Low platelet count.

Correct answer: D

Rationale: In a patient with cirrhosis, a low platelet count is the most concerning lab result. Thrombocytopenia, or low platelet count, is common in cirrhosis due to impaired platelet production in the liver. It significantly increases the risk of bleeding and can lead to serious complications such as hemorrhage. Elevated liver enzymes (Choice A) are expected in cirrhosis but may not directly indicate the severity of the disease. Low albumin levels (Choice B) are common in cirrhosis and can contribute to fluid retention but do not pose an immediate risk of bleeding. Elevated bilirubin levels (Choice C) are also expected in cirrhosis and typically indicate impaired liver function but do not directly increase the risk of bleeding as much as a low platelet count.

5. The patient is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient?

• A. Hypermagnesemia
• B. Hypernatremia
• C. Hypocalcemia
• D. Hypokalemia

Correct answer: D

Rationale: The correct answer is D: Hypokalemia. Thiazide diuretics like hydrochlorothiazide can cause hypokalemia. Hypokalemia enhances the effects of digoxin, leading to digoxin toxicity. Thiazides can also cause hypercalcemia. Choices A, B, and C are incorrect. Hypermagnesemia is not typically associated with hydrochlorothiazide use. Hypernatremia and hypocalcemia are not the primary electrolyte imbalances to monitor for in this scenario.

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