Nokea
The nurse preceptor is orienting a newly hired nurse caring for a client with advanced polycystic kidney disease (PKD). Which of the following actions by the newly hired nurse would require follow-up by the nurse preceptor?
- A. Requesting a prescription for ketorolac to help relieve the client's pain.
- B. Instructing the client on how to use guided imagery as a comfort strategy.
- C. Applying dry heat to the client's abdomen or flank for pain relief.
- D. Provides the client with foods high in fiber and low in salt.
Correct Answer: A
Rationale: Ketorolac, an NSAID, can worsen renal function in PKD and requires follow-up.
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The nurse cares for a client diagnosed with end-stage renal disease who just returned from initial hemodialysis. Which of the following assessment findings is of the highest concern?
- A. Headache and nausea
- B. Scant blood on the AV fistula
- C. Potassium 3.7 mEq/L (mmol/L) [3.5-5.0 mEq/L, mmol/L]
- D. Hemoglobin 8.8 g/dL [Male: 14-18 g/dL; Female: 12-16 g/dL, Female 115-155 g/L Male 125-170 g/L]
Correct Answer: A
Rationale: Headache and nausea may indicate dialysis disequilibrium syndrome, a serious complication requiring immediate attention.
The nurse is caring for a client who is severely hypernatremic. The nurse should prioritize assessing the client's
- A. cardiovascular status.
- B. genitourinary status.
- C. neurological status.
- D. gastrointestinal status.
Correct Answer: C
Rationale: Hypernatremia affects neurological status due to cellular dehydration, causing confusion, seizures, or coma, requiring priority assessment.
The nurse cares for a client with a potassium of 3.1 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L]. The primary healthcare provider (PHCP) prescribed 40 mEq of intravenous (IV) potassium over four hours. Which assessment finding would indicate a therapeutic effect?
- A. normoactive bowel sounds
- B. flattened T-waves
- C. reduced deep tendon reflexes
- D. muscle cramping
Correct Answer: B
Rationale: Hypokalemia can cause peaked T-waves on ECG. A therapeutic effect of potassium administration would be normalization of ECG, indicated by flattened T-waves. Normoactive bowel sounds (A), reduced reflexes (C), and muscle cramping (D) are not specific indicators of corrected hypokalemia.
The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 2 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
The nurse focuses on the client's serum sodium level and recognizes which conditions may cause hyponatremia or hypernatremia. For each condition below, click to specify if it causes hyponatremia or hypernatremia.
- A. syndrome of inappropriate antidiuretic hormone (SIADH)
- B. diabetes insipidus (DI)
- C. adrenal insufficiency
- D. Cushing's syndrome
Correct Answer: A: Hyponatremia, B: Hypernatremia, C: Hyponatremia, D: Hypernatremia
Rationale: SIADH and adrenal insufficiency cause hyponatremia via water retention or sodium loss. DI and Cushing's syndrome cause hypernatremia via water loss or sodium retention.
The nurse is caring for a client with hypokalemia scheduled to receive the prescribed 20 mEq of intravenous (IV) potassium. Which client assessment requires notification of the primary healthcare provider (PHCP)?
- A. Oliguria
- B. Abdominal distention
- C. Muscle weakness
- D. Weak peripheral pulses
Correct Answer: A
Rationale: Oliguria indicates poor renal function, which can lead to potassium accumulation, requiring PHCP notification before IV potassium administration.