Nursing Elites

1. The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two hours is dated two years ago. The client reports that he has a history of 'heart trouble,' but has no problems at present. Hospital protocol requires that those over 50 years of age have a recent ECG prior to surgery. What nursing action is best for the nurse to implement?

• A. Ask the client to explain what he means by 'heart trouble.'
• B. Call for an ECG to be performed immediately.
• C. Notify surgery that the ECG is over two years old.
• D. Notify the client's surgeon immediately.

Correct answer: B

Rationale: In this scenario, the client is 55 years old with a history of 'heart trouble,' which necessitates a recent ECG before surgery as per hospital policy. The nurse should prioritize patient safety and adhere to the protocol by arranging for an ECG to be performed immediately. Option A is not the best initial action as the focus should be on obtaining the necessary test first. Option C is not the immediate action required, and option D is premature without obtaining the necessary ECG first.

2. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

3. When a young client being taught to use an inhaler for asthma symptoms states the intention to use the inhaler but plans to continue smoking cigarettes, what is the best initial action by the nurse?

• A. Inform the healthcare provider of the client's statement.
• B. Explain that denial of illness can interfere with the treatment regimen.
• C. Revise the plan of care based on the client's plans to continue smoking.
• D. Review factors surrounding the client's beliefs about smoking cessation.

Correct answer: B

Rationale: The best initial action by the nurse when a client expresses plans to use an inhaler for asthma symptoms but continue smoking cigarettes is to address denial. By explaining that denial of illness can interfere with the treatment regimen, the nurse educates the client about the impact of smoking on asthma treatment. This approach helps the client understand the importance of smoking cessation in managing asthma symptoms. Informing the healthcare provider (Choice A) may be necessary but is not the initial action in this scenario. Revising the plan of care (Choice C) should be considered after addressing the client's denial and educating them. Reviewing factors surrounding the client's beliefs about smoking cessation (Choice D) is relevant but not the best initial action when denial is identified.

4. A client with partial thickness burns to the lower extremities is scheduled for whirlpool therapy to debride the burned area. Which intervention should the nurse implement before transporting the client to the physical therapy department?

• A. Obtain supplies to re-dress the burn area.
• B. Verify the client's signed consent form.
• C. Give a prescribed narcotic analgesic agent.
• D. Perform active range-of-motion exercises.

Correct answer: C

Rationale: Before transporting the client for whirlpool therapy to debride the burned area, the nurse should give a prescribed narcotic analgesic agent. This intervention is essential to manage pain effectively during the debridement process. Obtaining supplies to re-dress the burn area (Choice A) is important but not as immediate as providing pain relief. Verifying the client's signed consent form (Choice B) is necessary for procedures but does not address the client's immediate pain needs. Performing active range-of-motion exercises (Choice D) is not indicated before whirlpool therapy for debridement of burns and may cause further discomfort to the client.

5. A client with chronic renal failure is being treated with sodium polystyrene sulfonate (Kayexalate). The nurse should monitor the client for which of the following?

• A. Hyponatremia.
• B. Hypokalemia.
• C. Hyperkalemia.
• D. Hypocalcemia.

Correct answer: C

Rationale: The correct answer is C: Hyperkalemia. Sodium polystyrene sulfonate (Kayexalate) is used to treat high potassium levels (hyperkalemia) by exchanging sodium ions for potassium ions in the large intestine, which is then eliminated through the feces. Therefore, the nurse should monitor the client for changes in potassium levels to ensure the effectiveness of the treatment. Choices A, B, and D are incorrect because sodium polystyrene sulfonate (Kayexalate) is not associated with causing hyponatremia, hypokalemia, or hypocalcemia.

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