Nursing Elites

1. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which finding indicates the need for immediate intervention?

• A. Use of accessory muscles
• B. Oxygen saturation of 94%
• C. Carbon dioxide level of 45 mmHg
• D. Respiratory rate of 20 breaths per minute

Correct answer: C

Rationale: A carbon dioxide level of 45 mmHg is concerning in a client with COPD receiving supplemental oxygen, as it may indicate carbon dioxide retention and requires immediate intervention. Options A, B, and D are not the priority findings in this scenario. While the use of accessory muscles, an oxygen saturation of 94%, and a respiratory rate of 20 breaths per minute are important to monitor in a client with COPD, they do not indicate an immediate need for intervention like an elevated carbon dioxide level does.

2. A client with chronic kidney disease (CKD) is scheduled for a hemodialysis session. Which laboratory value should the nurse monitor closely?

• A. Serum potassium
• B. Serum creatinine
• C. Serum sodium
• D. Serum chloride

Correct answer: C

Rationale: The correct answer is C: Serum sodium. In a client with chronic kidney disease (CKD) scheduled for hemodialysis, monitoring serum sodium levels closely is essential. Hemodialysis can cause rapid shifts in sodium levels, leading to electrolyte imbalances. While serum potassium (choice A) is important to monitor in CKD, it is not the most crucial before hemodialysis. Serum creatinine (choice B) is an indicator of kidney function but is not the most immediate concern before hemodialysis. Serum chloride (choice D) is not typically the primary electrolyte of concern in CKD patients before hemodialysis.

3. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value should the nurse review before the procedure?

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

Correct answer: B

Rationale: Before a renal biopsy, the nurse should review the serum creatinine level. Serum creatinine is a key indicator of kidney function. In clients with chronic kidney disease (CKD), monitoring creatinine levels is crucial as elevated levels may indicate worsening kidney function, which could impact the safety and outcome of the biopsy. Hemoglobin (choice C) is important for assessing oxygen-carrying capacity but is not directly related to the kidney biopsy procedure. Serum potassium (choice A) is important to monitor in CKD but is not specifically crucial before a renal biopsy. White blood cell count (choice D) is more relevant for assessing infection or inflammation, which is not the primary concern before a renal biopsy.

4. A client with chronic obstructive pulmonary disease (COPD) is experiencing shortness of breath and has a prescription for oxygen therapy. What is the maximum amount of oxygen the nurse should administer without a healthcare provider's order?

• A. 2 liters per minute
• B. 4 liters per minute
• C. 6 liters per minute
• D. 8 liters per minute

Correct answer: B

Rationale: The correct answer is 4 liters per minute. Without a healthcare provider's order, the nurse should administer a maximum of 4 liters per minute of oxygen to prevent carbon dioxide retention in COPD clients. Higher flow rates can lead to oxygen toxicity and worsen the client's condition. Choices A, C, and D exceed the safe limit for oxygen administration without a healthcare provider's order.

5. The nurse is assessing a client with right-sided heart failure. Which finding requires immediate intervention?

• A. Jugular venous distention
• B. Peripheral edema
• C. Crackles in the lungs
• D. Elevated liver enzymes

Correct answer: C

Rationale: In a client with right-sided heart failure, crackles in the lungs are the most concerning finding as they indicate pulmonary congestion, which requires immediate intervention. Crackles suggest fluid accumulation in the lungs, leading to impaired gas exchange and potential respiratory distress. Jugular venous distention (Choice A) and peripheral edema (Choice B) are common findings in right-sided heart failure but do not indicate acute deterioration requiring immediate intervention. Elevated liver enzymes (Choice D) may be seen in chronic heart failure but do not warrant immediate action compared to the urgent need to address pulmonary congestion indicated by crackles in the lungs.

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