A client who was discharged 8 months ago with cirrhosis and ascites is admitted with anorexia and recent hemoptysis. The client is drowsy but responds to verbal stimuli. The nurse programs a blood pressure monitor to take readings every 15 minutes,. Which assessment should the nurse implement first?

Correct Answer: D

Rationale: In this scenario, the nurse should first palpate the abdomen for tenderness and rigidity. This is important because the client has a history of cirrhosis and ascites, which can lead to complications such as spontaneous bacterial peritonitis (SBP) or gastrointestinal bleeding. Palpating the abdomen can help assess for signs of infection, bleeding, or organ damage, all of which require immediate attention. Option A, evaluating distal capillary refill, is not the priority in this case because the client's current symptoms suggest more urgent issues related to their underlying condition. Checking extremities for bruising and petechiae (Option B) is not as crucial as assessing the abdomen in a client with cirrhosis and ascites. Similarly, examining the pretibial regions for pitting edema (Option C) is less urgent compared to assessing for abdominal tenderness and rigidity in this situation. Educationally, this question highlights the importance of prioritizing assessments based on the client's presenting symptoms and medical history. It reinforces the need for nurses to be able to quickly identify potential complications in clients with chronic conditions and to respond promptly to changes in their condition. This type of critical thinking is essential in providing safe and effective care to pediatric clients with complex health needs.

Correct Answer: A

Rationale: In this question, the correct answer is A) 0.8 ml. To determine the correct dosage to administer, the nurse needs to calculate based on the concentration of the medication in the vial and the prescribed dose. Since each 1 ml of the solution contains 10,000 units of epoetin alfa, and the prescribed dose is 8,200 units, the nurse should administer 0.8 ml (8,200 units / 10,000 units/ml = 0.82 ml). Option B) 8 ml is incorrect because it does not consider the concentration of the medication in the vial. Option C) 0 ml is incorrect as the patient does require medication administration. Option D) 1 ml is incorrect as it would result in administering more medication than the prescribed dose. Educationally, this question highlights the importance of medication dosage calculations in nursing practice, especially in the context of pediatric patients with specific conditions like chronic kidney disease. Nurses must have a strong understanding of medication concentrations and prescribed doses to ensure accurate and safe administration, emphasizing the critical role of pharmacology knowledge in nursing care.

Correct Answer: A

Rationale: In this scenario, the nurse should report a potassium level of 6.5 mEq/L (mmol/L) to the healthcare provider immediately. In patients with chronic kidney disease (CKD), especially those who missed dialysis, hyperkalemia (high potassium levels) can occur. High potassium levels can lead to serious cardiac arrhythmias, which can be life-threatening. The symptoms of shortness of breath, weakness, and the elevated heart rate in this patient may be indicative of cardiac distress due to hyperkalemia. Option A (Potassium 6.5 mEq/L) is the correct answer because it reflects the critical value of hyperkalemia that requires immediate intervention. Option B (Potassium 6 mEq/L) is incorrect because it is still elevated but not as critical as 6.5 mEq/L. Options C (Potassium 0.5 mEq/L) and D (Potassium 1.5 mEq/L) are both extremely low potassium levels, indicating hypokalemia, which is not consistent with the clinical presentation of the patient and is not the immediate concern. Educationally, this question highlights the importance of recognizing critical laboratory values, understanding the implications of electrolyte imbalances in patients with CKD, and the need for prompt intervention to prevent serious complications in this population. Nurses must be vigilant in monitoring and managing electrolyte levels in patients with renal impairment to ensure optimal outcomes.

Correct Answer: A

Rationale: In the context of a client with chronic pancreatitis experiencing persistent gnawing abdominal pain, the most important assessment data for the nurse to obtain is eating patterns and dietary intake (Option A). This is crucial because in pancreatitis, the pancreas is inflamed and struggles to produce digestive enzymes, leading to malabsorption of nutrients. Certain foods can exacerbate pancreatitis symptoms, such as fatty or spicy foods. By assessing the client's eating patterns and dietary intake, the nurse can identify potential triggers for the abdominal pain and provide appropriate dietary recommendations to manage the pain and prevent further complications. Option B, level and amount of physical activity, while important in overall health management, is not directly related to managing abdominal pain in chronic pancreatitis. Option C, color and consistency of feces, is more indicative of pancreatic enzyme insufficiency, which may manifest as steatorrhea (fatty stools) but is not directly related to managing abdominal pain. Option D, presence and activity of bowel sounds, is more relevant in assessing gastrointestinal motility but may not directly address the underlying cause of the abdominal pain in chronic pancreatitis. Educationally, understanding the relationship between diet and pancreatitis symptoms is crucial for nurses caring for clients with this condition. By emphasizing the importance of assessing eating patterns and dietary intake, nurses can contribute significantly to symptom management and overall well-being of their clients with chronic pancreatitis.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer. The nurse should explain to the client that it will be necessary to continue prophylactic doses of IV or aerosol pentamidine every month. This is crucial because pentamidine is used as a prophylactic treatment to prevent Pneumocystis carinii pneumonia (PCP) in individuals with AIDS. It helps to prevent the recurrence of the opportunistic infection. Option A is incorrect because IV pentamidine is not used to offer protection against other AIDS-related conditions like Kaposi's sarcoma. Option C is incorrect as IV pentamidine is not necessarily given until oral pentamidine can be tolerated, as the mode of administration may differ based on the individual's condition and response to therapy. Option D is incorrect as AZT therapy does not need to be stopped when IV or aerosol pentamidine is being used, as they serve different purposes in managing HIV/AIDS. Educationally, understanding the rationale behind prophylactic treatments like pentamidine in AIDS patients is crucial for nurses to provide comprehensive care. It highlights the importance of medication adherence and patient education in preventing opportunistic infections and improving outcomes for individuals living with HIV/AIDS.