Nursing Elites

1. An adult female client with chronic kidney disease (CKD) asks the nurse if she can continue taking over-the-counter medications. Which medication provides the greatest threat to this client?

• A. Magnesium hydroxide (Maalox).
• B. Birth control pills.
• C. Cough syrup containing codeine.
• D. Cold medication containing alcohol.

Correct answer: A

Rationale: The correct answer is A: Magnesium hydroxide (Maalox). In clients with CKD, magnesium can accumulate to toxic levels due to decreased excretion by the kidneys. Therefore, it poses the greatest threat to this client population. Choice B, birth control pills, is not typically contraindicated in CKD. Choice C, cough syrup containing codeine, may require dose adjustments but is not the greatest threat. Choice D, cold medication containing alcohol, is a concern mainly in liver disease, not CKD.

2. The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation. Which assessment finding requires immediate intervention?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 28 breaths per minute
• C. Tidal volume of 300 ml
• D. Blood pressure of 110/70 mmHg

Correct answer: C

Rationale: The correct answer is C. A tidal volume of 300 ml is concerning in a client with ARDS on mechanical ventilation because it indicates hypoventilation, which can lead to inadequate gas exchange and worsening respiratory status. This finding requires immediate intervention to optimize ventilation and oxygenation. Options A, B, and D are not as critical in this scenario. An oxygen saturation of 90% may be acceptable depending on the client's baseline condition and the target range set by the healthcare provider. A respiratory rate of 28 breaths per minute is slightly elevated but may not be immediately alarming. A blood pressure of 110/70 mmHg is within normal limits and does not require urgent intervention.

3. A client is being treated with an aminoglycoside antibiotic for a serious gram-negative infection. What nursing action should be included in the plan of care to prevent nephrotoxicity?

• A. Monitor serum creatinine levels daily.
• B. Administer the antibiotic over a longer period of time.
• C. Encourage increased fluid intake.
• D. Restrict dietary protein intake.

Correct answer: A

Rationale: Monitoring serum creatinine levels daily is the essential nursing action to prevent nephrotoxicity from aminoglycoside antibiotics. Aminoglycosides can cause kidney damage, so monitoring serum creatinine levels helps in detecting early signs of nephrotoxicity. Administering the antibiotic over a longer period of time (choice B) does not directly prevent nephrotoxicity. Encouraging increased fluid intake (choice C) is a general good practice but not specifically aimed at preventing nephrotoxicity. Restricting dietary protein intake (choice D) is not a direct preventive measure against aminoglycoside-induced nephrotoxicity.

4. A female client is admitted with end-stage pulmonary disease, is alert, oriented, and complaining of shortness of breath. The client tells the nurse that she wants 'no heroic measures' taken if she stops breathing, and she asks the nurse to document this in her medical record. What action should the nurse implement?

• A. Ask the client to discuss 'do not resuscitate' with her healthcare provider
• B. Document the client's wishes in her medical record
• C. Ask the client to sign an advance directive
• D. Place a 'Do Not Resuscitate' (DNR) order in the client's chart

Correct answer: A

Rationale: The correct action for the nurse to implement is to ask the client to discuss 'do not resuscitate' (DNR) wishes with her healthcare provider. This is important to ensure that the client makes informed decisions regarding her care. While documenting the client's wishes in her medical record is essential, it is crucial that the client discusses these wishes with the healthcare provider to understand the implications and have the DNR order legally documented. Asking the client to sign an advance directive is premature without a detailed discussion with the healthcare provider. Placing a 'Do Not Resuscitate' (DNR) order in the client's chart should only be done after the client has discussed and agreed upon this decision with the healthcare provider.

5. The nurse is caring for a client with a history of myocardial infarction who is experiencing chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: Corrected Rationale: An electrocardiogram (ECG) should be performed first to assess for cardiac ischemia in a client with a history of myocardial infarction and chest pain. An ECG provides immediate information about the heart's electrical activity, helping to identify changes indicative of cardiac ischemia or infarction. Chest X-ray (Choice B) is not the initial diagnostic test for assessing chest pain related to myocardial infarction. Arterial blood gases (Choice C) are used to assess oxygenation and acid-base balance but are not the primary diagnostic test for myocardial infarction. An echocardiogram (Choice D) may provide valuable information about cardiac structure and function, but it is not the first-line diagnostic test for acute chest pain in a client with a history of myocardial infarction.

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