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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.
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The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which assessment finding is most concerning?
- A. Increased fatigue
- B. Elevated blood pressure
- C. Low urine output
- D. Elevated hemoglobin
Correct Answer: B
Rationale: In a client with chronic kidney disease (CKD) receiving erythropoietin therapy, an elevated blood pressure is the most concerning assessment finding. Elevated blood pressure can indicate worsening hypertension, which requires immediate intervention. Increased fatigue may be expected due to anemia associated with CKD and erythropoietin therapy. Low urine output may indicate impaired kidney function but is not as immediately concerning as elevated blood pressure. Elevated hemoglobin levels are the desired outcome of erythropoietin therapy, indicating an appropriate response to treatment.
The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which laboratory value is most concerning?
- A. Serum sodium of 135 mEq/L
- B. Serum potassium of 4.0 mEq/L
- C. Serum bicarbonate of 18 mEq/L
- D. Serum glucose of 300 mg/dL
Correct Answer: C
Rationale: A serum bicarbonate level of 18 mEq/L is most concerning in a client with COPD as it indicates metabolic acidosis, requiring immediate intervention. In COPD, patients often retain carbon dioxide, leading to respiratory acidosis. A low serum bicarbonate level suggests that the body is compensating for this respiratory acidosis by increasing bicarbonate levels to maintain balance. Therefore, a low serum bicarbonate level in this scenario is alarming. Choices A, B, and D are within normal ranges and not directly related to the acid-base imbalance seen in COPD.
A male client is having abdominal pain after a left femoral angioplasty and stent, and is asking for additional pain medication for right lower quadrant pain (9/10). Two hours ago, he received hydrocodone/acetaminophen 7.5/325 mg. His vital signs are elevated from previous readings: temperature 97.8°F, heart rate 102 beats/minute, respiration 20 breaths/minute. His abdomen is swollen, the groin access site is tender, peripheral pulses are present, but the left is greater than the right. What data is needed to make this report complete?
- A. Client's lungs are clear bilaterally, and oxygen saturation is 97%.
- B. Surgeon needs to see the client immediately to evaluate the situation.
- C. Left peripheral pulses were present only by Doppler pre-procedure.
- D. Client's history includes multiple back surgeries and chronic pain.
Correct Answer: B
Rationale: The correct answer is B. In this scenario, the client is experiencing abdominal pain after a left femoral angioplasty and stent, with signs of potential complications such as a swollen abdomen, tenderness at the groin access site, and unequal peripheral pulses. The client's vital signs are also elevated, indicating a worsening condition. Given these findings, the immediate evaluation by the surgeon is crucial to assess for serious complications like internal bleeding or ischemia. Choice A is incorrect as the focus should be on the urgent need for surgical evaluation rather than lung sounds and oxygen saturation. Choice C is irrelevant to the immediate management of the client's current situation. Choice D, while providing background information, is not essential for the urgent intervention required in this case.
A nurse is caring for a client with an indwelling urinary catheter. Which intervention is most important to include in the client's plan of care?
- A. Ensure the catheter is below the level of the bladder at all times.
- B. Change the catheter bag every 48 hours.
- C. Cleanse the perineal area daily.
- D. Perform catheter care daily.
Correct Answer: A
Rationale: The correct answer is to ensure the catheter is always below the level of the bladder. Placing the catheter tubing above the level of the bladder can lead to backflow of urine, causing urinary tract infections. Changing the catheter bag every 48 hours is important but not as crucial as maintaining proper catheter positioning. Cleaning the perineal area daily and performing catheter care are essential tasks but do not directly address the prevention of complications associated with catheter placement.
The nurse discovers that an elderly client with no history of cardiac or renal disease has an elevated serum magnesium level. To further investigate the cause of this electrolyte imbalance, what information is most important for the nurse to obtain from the client's medical history?
- A. Frequency of laxative use for chronic constipation
- B. Dietary intake of magnesium-rich foods
- C. Use of magnesium-containing supplements
- D. History of alcohol use
Correct Answer: A
Rationale: The correct answer is A. Frequent use of magnesium-containing laxatives can lead to hypermagnesemia, particularly in elderly clients. Option B, dietary intake of magnesium-rich foods, may contribute to elevated serum magnesium levels but is less likely the cause in this scenario. Option C, the use of magnesium-containing supplements, can also contribute to hypermagnesemia but is not as common in elderly clients without a history of using such supplements. Option D, history of alcohol use, is less relevant to the development of elevated serum magnesium levels compared to laxative use for chronic constipation.