Nursing Elites

1. The nurse is preparing a teaching care plan for the client diagnosed with nephritic syndrome. Which intervention should the nurse include?

• A. Discontinue the use of steroid therapy immediately if symptoms develop.
• B. Take diuretics as needed to treat the dependent edema in ankles.
• C. Increase the intake of dietary sodium every day to decrease fluid retention.
• D. Report any decrease in daily weight during treatment to the healthcare provider.

Correct answer: D

Rationale: The correct answer is D. Reporting a decrease in daily weight is crucial when managing nephritic syndrome as it can indicate worsening of the condition or dehydration. It is essential to monitor weight changes closely to assess the effectiveness of treatment and the client's fluid status. Choice A is incorrect because discontinuing steroid therapy abruptly can lead to complications; gradual tapering is usually recommended. Choice B is incorrect as diuretics should be taken as prescribed by the healthcare provider to manage fluid retention. Choice C is also incorrect because increasing dietary sodium can exacerbate fluid retention, which is counterproductive in nephritic syndrome.

2. The client diagnosed with acute vein thrombosis is receiving a continuous heparin drip, an intravenous anticoagulant. The health care provider orders warfarin (Coumadin), an oral anticoagulant. Which action should the nurse take?

• A. Discontinue the heparin drip before initiating the Coumadin
• B. Check the client’s INR before beginning Coumadin
• C. Clarify the order with the healthcare provider as soon as possible
• D. Administer the Coumadin along with the heparin drip as ordered

Correct answer: D

Rationale: The correct answer is to administer the Coumadin along with the heparin drip as ordered. Heparin and warfarin are often given together initially because warfarin takes a few days to become effective. Discontinuing the heparin drip before initiating Coumadin can increase the risk of clot formation. Checking the client's INR before starting Coumadin is important but not the immediate action required. Clarifying the order with the healthcare provider is not necessary as both medications are commonly used together.

3. Whenever possible, patients evacuated from the theater of operations who are expected to return within 60 days are admitted to which of the following?

• A. Civilian hospitals participating in the National Disaster Medical System
• B. DOD tri-service hospitals
• C. Department of Veterans Affairs hospitals
• D. Temporary field hospitals

Correct answer: B

Rationale: Patients evacuated from the theater of operations and expected to return within 60 days are admitted to DOD tri-service hospitals. These hospitals are well-equipped to handle military personnel and are strategically placed for operational efficiency. Choice A, civilian hospitals participating in the National Disaster Medical System, may not have the specialized care and resources required for military personnel. Choice C, Department of Veterans Affairs hospitals, cater to veterans rather than active-duty personnel in theater. Choice D, temporary field hospitals, might not provide the comprehensive care and resources needed for an extended period of treatment.

4. What intervention would be most important for the nurse to implement for the client with a left nephrectomy?

• A. Assess the intravenous fluids for rate and volume
• B. Change the surgical dressing daily at the same time
• C. Monitor the client’s medication levels daily
• D. Monitor the percentage of each meal eaten

Correct answer: A

Rationale: The correct answer is A: Assess the intravenous fluids for rate and volume. After a nephrectomy, monitoring intravenous fluids is crucial to ensure proper hydration and kidney function. Choice B is incorrect because changing the surgical dressing daily is important but not the most critical intervention. Choice C is incorrect as monitoring medication levels daily may be necessary but is not the priority after a nephrectomy. Choice D is irrelevant to the immediate postoperative care needed after a nephrectomy.

5. The client diagnosed with Type 2 diabetes mellitus is being taught about diet by the nurse. Which diet selection indicates the client understands the teaching?

• A. A submarine sandwich, potato chips, and diet cola
• B. Four (4) slices of a supreme thin-crust pizza and milk
• C. Smoked turkey sandwich, celery sticks, and unsweetened tea
• D. A roast beef sandwich, fried onion rings, and a cola

Correct answer: C

Rationale: The correct answer is C because a smoked turkey sandwich with celery sticks and unsweetened tea reflects a balanced and healthy choice suitable for a client with Type 2 diabetes mellitus. Turkey is a lean protein choice, celery sticks offer fiber and low calories, and unsweetened tea is a sugar-free beverage. Choices A, B, and D are incorrect as they include high-carb, high-fat, and sugary options that are not recommended for individuals with diabetes as they can spike blood sugar levels.

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