Nursing Elites

1. In a patient with asthma, which of the following is the most important indicator of respiratory function?

• A. Oxygen saturation.
• B. Respiratory rate.
• C. Arterial blood gases.
• D. Peak expiratory flow rate.

Correct answer: D

Rationale: The peak expiratory flow rate is the most important indicator of respiratory function in asthma because it measures how quickly air can be exhaled, reflecting the severity of airflow limitation. Oxygen saturation (Choice A) is important in assessing oxygenation, but it does not directly reflect respiratory function. Respiratory rate (Choice B) can provide information on breathing patterns but does not quantify airflow limitation. Arterial blood gases (Choice C) give information about gas exchange but are not as specific for assessing asthma control and severity as peak expiratory flow rate.

2. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient’s electrolytes with careful attention to the levels of which electrolytes?

• A. Calcium and magnesium
• B. Sodium and calcium
• C. Potassium and chloride
• D. Potassium and magnesium

Correct answer: D

Rationale: Before administering digoxin, the nurse must review the patient's electrolyte levels, focusing on potassium and magnesium. Hypomagnesemia, similar to hypokalemia, can enhance the action of digitalis and lead to digitalis toxicity. Laxatives and diuretics, like hydrochlorothiazide, can deplete both potassium and magnesium. Therefore, monitoring these electrolytes is crucial to prevent potential adverse effects associated with digoxin therapy. Choice A (Calcium and magnesium) is incorrect because calcium levels are not specifically mentioned as crucial for digoxin therapy. Choice B (Sodium and calcium) is incorrect as sodium is not typically monitored in relation to digoxin therapy. Choice C (Potassium and chloride) is incorrect because although potassium is vital, chloride is not typically associated with digoxin therapy.

3. In the staging process of Hodgkin's disease, what does Stage I indicate?

• A. Involvement of a single lymph node.
• B. Involvement of two or more lymph nodes on the same side of the diaphragm.
• C. Involvement of lymph node regions on both sides of the diaphragm.
• D. Involvement of diffuse disease of one or more extralymphatic organs.

Correct answer: A

Rationale: In the staging process of Hodgkin's disease, Stage I signifies the involvement of a single lymph node. This stage indicates localized disease with the disease being limited to a single lymph node or a group of adjacent nodes. Choices B, C, and D are incorrect because they describe more extensive involvement of lymph nodes, both sides of the diaphragm, or extralymphatic organs, which would correspond to higher stages in the staging system.

4. A client with chronic renal failure is receiving sodium polystyrene sulfonate (Kayexalate). The nurse should monitor the client for which of the following?

• A. Hyponatremia.
• B. Hypokalemia.
• C. Hyperkalemia.
• D. Hypocalcemia.

Correct answer: C

Rationale: Correct Answer: The correct answer is C, 'Hyperkalemia.' Sodium polystyrene sulfonate (Kayexalate) is a medication used to treat high potassium levels (hyperkalemia) by exchanging sodium ions for potassium ions in the intestines, leading to potassium removal from the body. Therefore, the nurse should monitor the client for changes in potassium levels to assess the effectiveness of the medication and prevent potential complications related to hyperkalemia. Choice A, 'Hyponatremia,' is incorrect as Kayexalate does not primarily affect sodium levels. Choice B, 'Hypokalemia,' is incorrect as Kayexalate is used to treat high potassium levels, not low. Choice D, 'Hypocalcemia,' is incorrect as Kayexalate does not directly impact calcium levels.

5. The nurse is monitoring a client with chronic renal failure who is receiving hemodialysis. The nurse should report which of the following findings immediately?

• A. Clear dialysate outflow.
• B. Weight gain of 2 lbs (0.9 kg) since the last treatment.
• C. Blood pressure of 130/80 mm Hg.
• D. Pulse rate of 72 bpm.

Correct answer: B

Rationale: The correct answer is B. Weight gain of 2 lbs (0.9 kg) since the last treatment is concerning in a client undergoing hemodialysis with chronic renal failure as it may indicate fluid overload. This finding requires immediate reporting and intervention to prevent complications such as fluid retention, pulmonary edema, or exacerbation of heart failure. Choices A, C, and D are not findings that require immediate attention in this context. Clear dialysate outflow is a normal finding during hemodialysis, a blood pressure of 130/80 mm Hg is within a normal range for many clients, and a pulse rate of 72 bpm is also within the expected range for most individuals.

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