Nursing Elites

1. A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should the nurse implement?

• A. Position the head of the bed (HOB) flat.
• B. Withhold intravenous fluids.
• C. Administer a bolus of IV fluids.
• D. Give an antihypertensive medication.

Correct answer: D

Rationale: In a client with a completed ischemic stroke, an elevated blood pressure like 180/90 mm Hg requires immediate intervention to prevent further damage. Giving an antihypertensive medication is essential to reduce the risk of recurrent stroke or complications related to hypertension. Positioning the head of the bed flat, withholding IV fluids, or administering a bolus of IV fluids are not appropriate actions for managing elevated blood pressure in this scenario and may not address the underlying cause of the hypertension or prevent potential complications.

2. A client with elevated levels of antidiuretic hormone (ADH) triggers the release of this hormone due to which disorder?

• A. Pneumonia
• B. Dehydration
• C. Renal failure
• D. Edema

Correct answer: B

Rationale: Antidiuretic hormone (ADH) increases tubular permeability to water, causing more water absorption into the capillaries. ADH is released in response to a rising extracellular fluid osmolarity, such as in dehydration. Pneumonia, renal failure, and edema do not typically lead to the release of ADH. Pneumonia is an inflammatory lung condition, renal failure affects kidney function, and edema is the accumulation of excess fluid in the tissues, none of which directly stimulate the release of ADH.

3. Which of the following is most important for assessing when evaluating the effects of peritoneal dialysis?

• A. Serum potassium levels
• B. Blood pressure
• C. Daily weight
• D. Serum sodium levels

Correct answer: C

Rationale: Daily weight is the most crucial parameter to assess when evaluating the effects of peritoneal dialysis because it directly reflects fluid balance. Peritoneal dialysis involves the removal of excess fluid and waste products from the body. Monitoring daily weight enables the healthcare provider to track changes in fluid status, ensuring that the dialysis treatment is effective. While serum potassium levels, blood pressure, and serum sodium levels are important parameters to monitor in patients undergoing dialysis, they are not as directly indicative of the immediate effects of peritoneal dialysis on fluid balance as daily weight.

4. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?

• A. Your immune system becomes less effective as you age.
• B. Low estrogen levels can make the tissue more susceptible to infection.
• C. You should be more careful with your personal hygiene in this area.
• D. It is likely that you have an untreated sexually transmitted disease.

Correct answer: B

Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.

5. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide should the nurse question for this patient?

• A. Azithromycin (Zithromax)
• B. Clarithromycin (Biaxin)
• C. Erythromycin (E-Mycin)
• D. Fidaxomicin (Dificid)

Correct answer: C

Rationale: The nurse should question the prescription of erythromycin for this patient. When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase. Therefore, it is not recommended to use erythromycin in combination with fluconazole for this patient. Azithromycin, clarithromycin, and fidaxomicin are alternative macrolide antibiotics that can be considered for this patient without the same risk of interactions when used with fluconazole.

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