Nursing Elites

1. Which client is at risk for hypomagnesemia?

• A. Client with a history of heart disease
• B. Client taking magnesium-based antacids
• C. Client with a parathyroid disorder
• D. Client admitted with alcohol abuse

Correct answer: D

Rationale: The correct answer is the client admitted with alcohol abuse. Alcoholics tend to have poor nutrition due to decreased food intake, which is a common source of magnesium. Additionally, alcohol suppresses the release of ADH, leading to diuresis and magnesium loss. Choice A is incorrect because a history of heart disease does not directly increase the risk of hypomagnesemia. Choice B is incorrect as taking magnesium-based antacids would not put the client at risk for hypomagnesemia; in fact, it would help prevent it. Choice C is also incorrect as a parathyroid disorder is not typically associated with an increased risk of hypomagnesemia.

2. After a left heart catheterization (LHC), a client complains of severe foot pain on the side of the femoral stick. The nurse notes pulselessness, pallor, and a cold extremity. What should the nurse's next action be?

• A. Administer an anticoagulant.
• B. Warm the room and re-assess.
• C. Increase IV fluids.
• D. Notify the physician stat.

Correct answer: D

Rationale: The correct action for the nurse to take next is to notify the physician immediately (stat). The client's symptoms of foot pain, pulselessness, pallor, and cold extremity suggest a potential vascular complication, such as arterial occlusion. Prompt notification of the physician is crucial as this condition requires urgent intervention to restore blood flow and prevent tissue damage. Administering an anticoagulant (Choice A) without physician evaluation could be harmful as the underlying cause needs to be determined first. Warming the room and re-assessing (Choice B) may delay necessary treatment. Increasing IV fluids (Choice C) is unlikely to address the urgent vascular issue indicated by the symptoms described.

3. A client who is newly diagnosed with Parkinson's disease and beginning medication therapy asks the nurse, 'How soon will I see improvement?' The nurse's best response is:

• A. "That varies from client to client."?
• B. "You should discuss that with your physician."?
• C. "You should notice a difference in a few days."?
• D. "It might take several weeks before you notice improvement."?

Correct answer: D

Rationale: In the case of Parkinson's disease, improvement in symptoms may take several weeks of therapy to become noticeable. Therefore, the correct answer is to inform the client that it might take several weeks before they notice improvement. Choice A acknowledges individual variability but does not provide a specific timeframe, making it less reassuring. Choice B suggests deferring the question to the physician, which is not the most supportive response. Choice C is incorrect because improvement in Parkinson's disease symptoms typically does not occur within a few days.

4. Teaching about the need to avoid foods high in potassium is most important for which client?

• A. a client receiving diuretic therapy
• B. a client with an ileostomy
• C. a client with metabolic alkalosis
• D. a client with renal disease

Correct answer: D

Rationale: Clients with renal disease are predisposed to hyperkalemia and should avoid foods high in potassium. High potassium levels can further burden the kidneys and worsen the condition. Choices A, B, and C are incorrect because clients receiving diuretic therapy, with an ileostomy, or with metabolic alkalosis are at risk for hypokalemia, which is low potassium levels. Therefore, these clients should actually be encouraged to eat foods high in potassium to maintain adequate levels and prevent complications associated with hypokalemia.

5. Why is starting a low CHO diet a contraindication for a client with renal insufficiency?

• A. As long as the client eats a minimum of 30g of CHO/day, there should be no problem.
• B. The client's clinical condition is a contraindication to starting a low CHO diet.
• C. Calcium supplements should be utilized to prevent the development of osteoporosis while on a low CHO diet.
• D. As long as the client eats foods that are high biologic protein sources, a low CHO diet can be followed.

Correct answer: B

Rationale: A client with renal insufficiency should not start a low CHO diet because it could result in an increased renal solute load. Clients with renal or liver disease require protein control in their diet to prevent complications. Proteins used must be of high biologic value, and protein intake is usually weight-based. Protein levels may be adjusted based on the client's clinical condition. A minimum level of carbohydrates is needed in the diet to spare protein. Vitamin and mineral supplements might be needed for clients with liver failure. The dietician plays a crucial role in calculating specific nutrient requirements for these clients and monitoring outcomes in conjunction with the healthcare team. Choice A is incorrect because simply consuming a minimum amount of carbohydrates does not address the issue of increased renal solute load. Choice C is incorrect as calcium supplements are not the primary concern when considering a low CHO diet for a client with renal insufficiency. Choice D is incorrect as the focus should be on the contraindication of a low CHO diet for a client with renal insufficiency rather than just high biologic protein sources.

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