Nursing Elites

1. A client with a history of diabetes mellitus is admitted with a foot ulcer. The nurse should recognize that which intervention is most critical in promoting healing of the foot ulcer?

• A. Strict control of blood glucose levels.
• B. Regular dressing changes with sterile technique.
• C. Application of antibiotic ointment.
• D. Hydrotherapy treatment daily.

Correct answer: A

Rationale: In diabetic clients with foot ulcers, strict control of blood glucose levels is essential for promoting wound healing. High blood glucose levels can impair circulation and compromise the body's ability to fight infection, delaying the healing process. By maintaining optimal blood glucose levels, the client's overall health and wound healing potential are improved.

2. A patient with chronic kidney disease (CKD) is prescribed calcium acetate. What is the primary purpose of this medication?

• A. Treat hyperkalemia
• B. Reduce phosphate levels
• C. Lower blood pressure
• D. Increase hemoglobin levels

Correct answer: B

Rationale: The primary purpose of prescribing calcium acetate to a patient with chronic kidney disease (CKD) is to reduce phosphate levels. Calcium acetate binds to dietary phosphate, preventing its absorption and helping to manage hyperphosphatemia commonly seen in CKD patients.

3. A client with chronic renal failure is prescribed epoetin alfa (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Decreased blood pressure.
• C. Improved hemoglobin levels.
• D. Stable potassium levels.

Correct answer: C

Rationale: Epoetin alfa is a medication that stimulates red blood cell production. Therefore, in a client with chronic renal failure, an effective outcome of epoetin alfa therapy would be an improvement in hemoglobin levels. This indicates that the medication is working as intended by addressing anemia, a common complication of chronic renal failure. Increased urine output (choice A) is not directly related to the action of epoetin alfa. Decreased blood pressure (choice B) is not a primary expected outcome of epoetin alfa therapy. Stable potassium levels (choice D) are important but not a direct indicator of the effectiveness of epoetin alfa in this context.

4. What instruction should the nurse include in the discharge teaching for a patient with hypothyroidism prescribed levothyroxine?

• A. Take the medication with meals.
• B. Take the medication in the morning on an empty stomach.
• C. Discontinue the medication if you feel better.
• D. Double the dose if a dose is missed.

Correct answer: B

Rationale: The correct instruction for a patient with hypothyroidism prescribed levothyroxine is to take the medication in the morning on an empty stomach to enhance absorption. Taking it with meals can interfere with absorption. Patients should not discontinue the medication without consulting their healthcare provider as it can lead to adverse effects. Doubling the dose if a dose is missed can increase the risk of side effects and overdosage. It is crucial for patients to follow the prescribed dosing schedule and consult their healthcare provider for any concerns or missed doses.

5. Following a CVA, the nurse assesses that a client has developed dysphagia, hypoactive bowel sounds, and a firm, distended abdomen. Which prescription for the client should the nurse question?

• A. Continuous tube feeding at 65 ml/hr via gastrostomy.
• B. Total parenteral nutrition to be infused at 125 ml/hour.
• C. Nasogastric tube connected to low intermittent suction.
• D. Metoclopramide (Reglan) intermittent piggyback.

Correct answer: A

Rationale: In a client with dysphagia and gastrointestinal symptoms such as hypoactive bowel sounds and a firm, distended abdomen, continuous tube feeding might exacerbate the symptoms. This can lead to complications and should be questioned by the nurse.

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