Nursing Elites

1. The nurse is caring for a client who is scheduled for hemodialysis. Which of the following laboratory values should the nurse monitor closely before, during, and after the procedure?

• A. Hemoglobin level.
• B. Blood urea nitrogen (BUN) level.
• C. Creatinine level.
• D. Serum potassium level.

Correct answer: D

Rationale: The correct answer is D: Serum potassium level. Before, during, and after hemodialysis, monitoring the serum potassium level is crucial to prevent hyperkalemia, a potentially life-threatening complication. Hemodialysis is done to remove waste products and excess electrolytes like potassium from the blood. Monitoring other laboratory values like hemoglobin, BUN, and creatinine is important in assessing kidney function and anemia, but serum potassium level requires close monitoring during hemodialysis due to the risk of rapid shifts that can lead to cardiac arrhythmias.

2. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take a laxative every night before going to bed.
• B. I must increase my intake of dietary fiber and fluids.
• C. I shall only use salt when I am cooking my own food.
• D. I’ll eat white bread to minimize gastrointestinal gas.

Correct answer: B

Rationale: Choice B is the correct answer. Clients with PKD often experience constipation, which can be managed by increasing their intake of dietary fiber and fluids. This helps promote bowel regularity. Laxatives should be used cautiously and not as a routine solution. Choice A is incorrect as regular laxative use is not recommended. Choice C is incorrect as a low-salt diet is typically advised for clients with PKD, not just limiting salt while cooking. Choice D is incorrect as white bread is low in fiber and not beneficial for managing constipation, which is common in PKD.

3. Which of the following is a common sign of meningitis?

• A. Joint pain.
• B. Severe headache.
• C. Stiff neck.
• D. Coughing up blood.

Correct answer: C

Rationale: A stiff neck is a common sign of meningitis due to inflammation of the meninges. Meningitis typically presents with symptoms such as fever, severe headache, nausea, vomiting, sensitivity to light, and a stiff neck. Joint pain (Choice A) is not a typical symptom of meningitis and is more commonly associated with other conditions. While severe headache (Choice B) can be a symptom of meningitis, it is not as specific as a stiff neck. Coughing up blood (Choice D) is not a typical sign of meningitis and may indicate other respiratory or cardiovascular issues.

4. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?

• A. Administer the amoxicillin and have epinephrine available.
• B. Ask the provider to order an antihistamine.
• C. Contact the provider to discuss using a different antibiotic.
• D. Request an order for a beta-lactamase-resistant drug.

Correct answer: C

Rationale: When a patient has a history of rash from penicillin, it indicates a potential allergic reaction to penicillin and other related drugs, such as amoxicillin. It is crucial to avoid administering penicillins to such patients unless there is no alternative. The nurse's best action in this situation is to contact the provider to discuss using a different antibiotic from a different class. This approach helps prevent potential severe allergic reactions. While epinephrine and antihistamines are used to manage allergic reactions, administering amoxicillin despite the known allergy is not advisable and could lead to serious consequences. Requesting a beta-lactamase-resistant drug does not address the issue of potential allergic reactions in this scenario.

5. A client with an oversecretion of renin has a health history reviewed by a nurse. Which disorder should the nurse correlate with this assessment finding?

• A. Alzheimer’s disease
• B. Hypertension
• C. Diabetes mellitus
• D. Viral hepatitis

Correct answer: B

Rationale: Renin is secreted in response to low blood volume, blood pressure, or blood sodium levels. Excessive renin secretion can lead to persistent hypertension. Renin plays no role in Alzheimer's disease, diabetes mellitus, or viral hepatitis. Therefore, the correct correlation with oversecretion of renin is hypertension.

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