A client with chronic renal failure is scheduled to receive epoetin alfa (Epogen). Which laboratory result should the nurse review before administering the medication?

Correct Answer: C

Rationale: The correct answer is C: Hemoglobin level. In chronic renal failure, the kidneys may not produce enough erythropoietin, leading to anemia. Epoetin alfa stimulates red blood cell production. Therefore, reviewing the hemoglobin level is crucial to determine the need for the medication. Incorrect choices: A: Blood urea nitrogen (BUN) and B: Creatinine clearance are indicators of kidney function but not directly related to monitoring the effectiveness of epoetin alfa. D: Serum potassium is important in renal failure but not specifically needed to review before administering epoetin alfa.

Correct Answer: C

Rationale: The correct answer is C: Clear lung sounds. Clear lung sounds indicate effective treatment as they suggest improved air exchange and resolution of lung congestion caused by pneumonia. Increased respiratory rate (A) and decreased oxygen saturation (B) are signs of respiratory distress and ineffective treatment. Elevated white blood cell count (D) indicates ongoing infection, not effectiveness of treatment. Therefore, clear lung sounds are the best indicator of treatment effectiveness in bacterial pneumonia.

Correct Answer: C

Rationale: The correct answer is C: Urine output of 20 ml/hour. In severe dehydration, decreased urine output indicates compromised renal function and impaired fluid balance, necessitating immediate intervention to prevent further complications. A: Heart rate of 110 bpm is elevated but not an immediate concern. B: Blood pressure of 90/60 mm Hg is low but may be compensated in dehydration. D: Dry mucous membranes are a sign of dehydration but not an immediate threat compared to inadequate urine output.

Correct Answer: D

Rationale: The correct answer is D, Both A and C. Brudzinski's sign and Kernig's sign are both indicative of meningeal irritation. Brudzinski's sign is when flexion of the neck causes involuntary flexion of the hip and knee. Kernig's sign is when there is resistance or pain with knee extension after hip flexion. These signs suggest inflammation of the meninges, commonly seen in meningitis. Babinski reflex (choice B) is not specific to meningitis and is related to upper motor neuron dysfunction. Therefore, the correct answer is D as it includes the two most relevant signs for meningeal irritation, while the other choices are not directly associated with this condition.

Correct Answer: A

Rationale: The correct answer is A: Thiamine (Vitamin B1). Chronic alcohol use can lead to thiamine deficiency, causing neurological symptoms like confusion and unsteady gait (Wernicke's encephalopathy). Thiamine is crucial for brain function and alcohol interferes with its absorption. Vitamin B12 (choice B) deficiency can also cause neurological symptoms but is less likely in this case. Folic acid (choice C) deficiency can lead to anemia and neural tube defects, not directly related to the symptoms described. Vitamin D (choice D) deficiency typically presents with bone pain and muscle weakness, not confusion and gait issues.

Correct Answer: B

Rationale: The correct answer is B: Improved hemoglobin levels. Erythropoietin stimulates the production of red blood cells, leading to an increase in hemoglobin levels. This is the desired outcome in a client with chronic renal failure, as it helps alleviate anemia. Choice A is incorrect because increased urine output is not a direct indicator of erythropoietin effectiveness. Choice C is incorrect as erythropoietin does not directly impact blood pressure. Choice D is incorrect because stable potassium levels are not a primary outcome of erythropoietin therapy in chronic renal failure.

Correct Answer: A

Rationale: The correct answer is A: Increased anteroposterior chest diameter. In COPD, the chronic airway obstruction leads to air trapping, causing the chest to become hyperinflated. This results in an increase in the anteroposterior chest diameter, often referred to as "barrel chest." Explanation for why other choices are incorrect: B: Decreased respiratory rate is not typically seen in COPD; patients often exhibit an increased respiratory rate due to difficulty breathing. C: Dull percussion sounds over the lungs are associated with conditions like pneumonia or pleural effusion, not COPD. D: Hyperresonance on chest percussion is typically found in conditions like emphysema, a type of COPD, but it is not specific to COPD as a whole.

Correct Answer: C

Rationale: The correct answer is C: Hemoglobin level. In chronic renal failure, the kidneys may not produce enough erythropoietin, leading to anemia. Epoetin alfa stimulates red blood cell production. Therefore, reviewing the hemoglobin level is crucial to determine the need for the medication. Incorrect choices: A: Blood urea nitrogen (BUN) and B: Creatinine clearance are indicators of kidney function but not directly related to monitoring the effectiveness of epoetin alfa. D: Serum potassium is important in renal failure but not specifically needed to review before administering epoetin alfa.

Correct Answer: C

Rationale: The correct answer is C: Ensure the client's bladder is emptied regularly. Autonomic dysreflexia is a potentially life-threatening condition that occurs in clients with spinal cord injuries. It is triggered by a distended bladder or bowel. By regularly emptying the client's bladder, the nurse can prevent the stimulus that leads to autonomic dysreflexia. Option A is incorrect because restricting fluid intake can lead to dehydration, exacerbating the condition. Option B is incorrect as temperature regulation is not directly related to preventing autonomic dysreflexia. Option D is incorrect as high-fiber foods do not play a role in triggering this condition.