Nursing Elites

1. The nurse discovers that an elderly client with no history of cardiac or renal disease has an elevated serum magnesium level. To further investigate the cause of this electrolyte imbalance, what information is most important for the nurse to obtain from the client's medical history?

• A. Frequency of laxative use for chronic constipation
• B. Dietary intake of magnesium-rich foods
• C. Use of magnesium-containing supplements
• D. History of alcohol use

Correct answer: A

Rationale: The correct answer is A. Frequent use of magnesium-containing laxatives can lead to hypermagnesemia, particularly in elderly clients. Option B, dietary intake of magnesium-rich foods, may contribute to elevated serum magnesium levels but is less likely the cause in this scenario. Option C, the use of magnesium-containing supplements, can also contribute to hypermagnesemia but is not as common in elderly clients without a history of using such supplements. Option D, history of alcohol use, is less relevant to the development of elevated serum magnesium levels compared to laxative use for chronic constipation.

2. What is the most important instruction for the nurse to provide a client being discharged following treatment for Guillain-Barre syndrome?

• A. Avoid exposure to respiratory infections.
• B. Use relaxation exercises when anxious.
• C. Continue physical therapy at home.
• D. Plan short, frequent rest periods.

Correct answer: A

Rationale: The most critical instruction for a client being discharged following treatment for Guillain-Barre syndrome is to avoid exposure to respiratory infections. Guillain-Barre syndrome can affect the respiratory system, making infections particularly dangerous. While relaxation exercises, physical therapy, and rest periods are beneficial for overall well-being and recovery, preventing respiratory infections takes precedence due to the potential life-threatening complications associated with respiratory compromise in Guillain-Barre syndrome.

3. The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value should be closely monitored?

• A. Serum potassium level
• B. Hemoglobin level
• C. White blood cell count
• D. Serum sodium level of 135 mEq/L

Correct answer: A

Rationale: The correct answer is A: Serum potassium level. In clients receiving erythropoietin therapy for chronic kidney disease, monitoring serum potassium levels is crucial due to the risk of developing hyperkalemia. Erythropoietin therapy can stimulate red blood cell production, leading to an increase in potassium levels. Monitoring potassium levels helps prevent complications associated with hyperkalemia, such as cardiac arrhythmias. Choices B, C, and D are incorrect because while hemoglobin levels are relevant for assessing the effectiveness of erythropoietin therapy, monitoring potassium levels is more critical due to the potential adverse effects of elevated potassium levels in CKD patients on this therapy.

4. A 65-year-old male client with a history of smoking and high cholesterol is admitted with shortness of breath and 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. Pulmonary function tests (PFTs)

Correct answer: A

Rationale: The correct answer is an Electrocardiogram (ECG). An ECG should be performed first to assess for cardiac ischemia, especially given the client's symptoms and history. Chest X-ray (Choice B) may be ordered to evaluate the lungs but would not be the initial test for this client presenting with chest pain and shortness of breath. Arterial blood gases (ABGs) (Choice C) are used to assess oxygenation and acid-base balance but are not the primary diagnostic test for a client with suspected cardiac issues. Pulmonary function tests (PFTs) (Choice D) are used to assess lung function and would not be the first test indicated in this scenario.

5. Following a gunshot wound to the abdomen, a young adult male had an emergency bowel resection and received multiple blood products. His current blood pressure is 78/52 mm Hg, and he is being mechanically ventilated. His oxygen saturation is 87%. Laboratory values indicate hemoglobin of 7 g/dL, platelets of 20,000/mm³, and white blood cells of 2,000/mm³. Which intervention should the nurse implement first?

• A. Transfuse packed red blood cells.
• B. Obtain blood and sputum cultures.
• C. Infuse 1000 ml of normal saline.
• D. Titrate oxygen to keep O2 saturation above 90%.

Correct answer: A

Rationale: The correct answer is to transfuse packed red blood cells first. The client's low hemoglobin level of 7 g/dL indicates severe anemia, which requires immediate transfusion to increase oxygen-carrying capacity. While obtaining blood and sputum cultures (Choice B) is important to identify potential infections, addressing the critical issue of anemia takes precedence. Infusing normal saline (Choice C) may help with volume status but does not address the primary concern of low hemoglobin. Titration of oxygen (Choice D) is crucial, but transfusion to improve oxygen-carrying capacity should be the priority in this scenario.

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