Nursing Elites

1. The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value should the nurse monitor closely?

• A. Serum potassium level
• B. Hemoglobin level
• C. White blood cell count
• D. Serum calcium level

Correct answer: A

Rationale: The correct answer is A: Serum potassium level. When a client with chronic kidney disease (CKD) is receiving erythropoietin therapy, the nurse should closely monitor the serum potassium level. Erythropoietin therapy can stimulate red blood cell production, leading to an increased demand for potassium. This increases the risk of hyperkalemia, making it crucial to monitor potassium levels closely. Choices B, C, and D are incorrect because erythropoietin therapy primarily affects red blood cell production, not hemoglobin, white blood cell count, or serum calcium levels.

2. A client with cirrhosis is admitted with jaundice and ascites. Which laboratory value requires immediate intervention?

• A. Serum albumin of 3.0 g/dL
• B. Serum bilirubin of 3.0 mg/dL
• C. Serum ammonia level of 80 mcg/dL
• D. Serum sodium level of 135 mEq/L

Correct answer: C

Rationale: A serum ammonia level of 80 mcg/dL is most concerning in a client with cirrhosis as it may indicate hepatic encephalopathy, requiring immediate intervention. High serum ammonia levels can lead to altered mental status, confusion, and even coma. Serum albumin (choice A) is often decreased in cirrhosis but does not require immediate intervention. Serum bilirubin (choice B) elevation is expected in cirrhosis and may not require immediate intervention unless very high. Serum sodium (choice D) within the given range is generally acceptable and does not require immediate intervention.

3. A male client with hypertension, who received new antihypertensive prescriptions at his last visit, returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106, and he admits that he has not been taking the prescribed medication because the drugs make him 'feel bad'. In explaining the need for hypertension control, the nurse should stress that an elevated BP places the client at risk for which pathophysiological condition?

• A. Blindness due to cataracts
• B. Acute kidney injury due to glomerular damage
• C. Stroke secondary to hemorrhage
• D. Heart block due to myocardial damage

Correct answer: C

Rationale: The correct answer is C, 'Stroke secondary to hemorrhage.' Uncontrolled hypertension can lead to the weakening of blood vessels in the brain, increasing the risk of a stroke due to hemorrhage. This can result in serious neurological deficits or even death. Choices A, B, and D are incorrect because while hypertension can have various complications including vision changes, kidney damage, and heart problems, the most immediate and severe risk associated with uncontrolled hypertension is a stroke from cerebral hemorrhage.

4. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which laboratory value should be closely monitored before the procedure?

• A. Serum creatinine of 2.0 mg/dl
• B. Serum potassium of 5.5 mEq/L
• C. Serum calcium of 8.0 mg/dl
• D. Hemoglobin of 12 g/dl

Correct answer: B

Rationale: A serum potassium level of 5.5 mEq/L is concerning in a client with ESRD scheduled for hemodialysis as it indicates hyperkalemia, which can lead to serious cardiac complications. Hyperkalemia can be exacerbated during hemodialysis, making it crucial to closely monitor serum potassium levels before the procedure. Monitoring serum creatinine, serum calcium, or hemoglobin levels is important in managing ESRD but is not the immediate focus before hemodialysis. Therefore, option B is the correct choice.

5. In a client with heart failure receiving digoxin (Lanoxin) and furosemide (Lasix), which laboratory value requires immediate intervention?

• A. Serum potassium of 4.0 mEq/L
• B. Blood glucose of 200 mg/dl
• C. Serum creatinine of 1.5 mg/dl
• D. Serum potassium of 3.2 mEq/L

Correct answer: D

Rationale: A serum potassium level of 3.2 mEq/L is low and concerning in a client receiving digoxin and furosemide. Hypokalemia increases the risk of digoxin toxicity, leading to life-threatening arrhythmias. Therefore, immediate intervention is necessary to prevent complications. The other options, serum potassium of 4.0 mEq/L, blood glucose of 200 mg/dl, and serum creatinine of 1.5 mg/dl, are within normal limits and do not pose immediate risks to the client in this scenario.

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