Nursing Elites

1. The nurse is assessing a client with left-sided heart failure. Which assessment finding requires immediate intervention?

• A. Jugular venous distention
• B. Shortness of breath
• C. Crackles in the lungs
• D. Peripheral edema

Correct answer: C

Rationale: In a client with left-sided heart failure, crackles in the lungs are a critical assessment finding that necessitates immediate intervention. Crackles indicate pulmonary congestion, a sign of worsening heart failure that requires prompt attention to prevent respiratory distress. Jugular venous distention, shortness of breath, and peripheral edema are also common in heart failure, but crackles specifically point to pulmonary involvement and the urgent need for intervention.

2. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value is most concerning?

• A. Serum potassium of 5.5 mEq/L
• B. Serum creatinine of 1.5 mg/dl
• C. Serum creatinine of 2.5 mg/dl
• D. White blood cell count of 8,000/mm3

Correct answer: C

Rationale: A serum creatinine level of 2.5 mg/dl is the most concerning laboratory value in a client with chronic kidney disease scheduled for a renal biopsy. An elevated serum creatinine level indicates impaired kidney function, which is critical information before performing a renal biopsy. Option A (Serum potassium of 5.5 mEq/L) may be concerning for hyperkalemia but is not directly related to the renal biopsy procedure. Option B (Serum creatinine of 1.5 mg/dl) is within normal limits, suggesting relatively normal kidney function. Option D (White blood cell count of 8,000/mm3) is within the normal range and not directly related to the renal biopsy procedure or CKD management.

3. A client with liver cirrhosis and ascites is admitted with jaundice. Which laboratory value is most concerning to the nurse?

• A. Serum albumin of 3.0 g/dl
• B. Bilirubin of 3.0 mg/dl
• C. Ammonia level of 80 mcg/dl
• D. Prothrombin time of 18 seconds

Correct answer: C

Rationale: An ammonia level of 80 mcg/dl is elevated and concerning in a client with liver cirrhosis, as it may indicate hepatic encephalopathy. Elevated ammonia levels can lead to neurological symptoms such as confusion, altered mental status, and even coma. Serum albumin, bilirubin, and prothrombin time are important in liver cirrhosis but are not the most concerning for acute neurological deterioration associated with hepatic encephalopathy.

4. To reduce staff nurse role ambiguity, which strategy should the nurse-manager implement?

• A. Review the staff nurse job description to ensure that it is clear, accurate, and current.
• B. Conduct regular meetings to clarify roles.
• C. Increase communication between team members.
• D. Provide additional training for new nurses.

Correct answer: A

Rationale: The correct answer is A: Review the staff nurse job description to ensure that it is clear, accurate, and current. By ensuring that job descriptions are clear and up-to-date, nurse-managers can reduce ambiguity and confusion about roles and responsibilities. Choice B, conducting regular meetings to clarify roles, may help but may not address the root cause of ambiguity. Choice C, increasing communication between team members, is important but may not specifically target role ambiguity. Choice D, providing additional training for new nurses, is valuable but may not directly address role ambiguity among existing staff.

5. A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?

• A. Serum creatinine of 1.8 mg/dl
• B. Prothrombin time of 18 seconds
• C. Hemoglobin of 9 g/dl
• D. Platelet count of 90,000/mm3

Correct answer: D

Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.

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