Nursing Elites

1. A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider?

• A. Do you want daily weights on this client?
• B. Will the client be able to return home?
• C. Can we discontinue the indwelling catheter?
• D. Should we get another chest x-ray today?

Correct answer: C

Rationale: An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

2. A nurse cares for a client with urinary incontinence. The client states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How should the nurse respond?

• A. I understand how you feel. I would be mortified.
• B. Incontinence pads will minimize leaks in public.
• C. I can teach you strategies to help control your incontinence.
• D. More women experience incontinence than you might think.

Correct answer: C

Rationale: The nurse should accept and acknowledge the client’s concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client’s concerns with the use of pads or stating statistics about the occurrence of incontinence.

3. A client with a family history of polycystic kidney disease (PKD is being assessed by a nurse. For which clinical manifestations should the nurse assess? (Select all that apply.)

• A. Nocturia
• B. Flank pain
• C. Increased abdominal girth
• D. B & C

Correct answer: D

Rationale: Clients with PKD commonly present with flank pain and increased abdominal girth due to abdominal distention caused by cysts. Bloody urine is also a common symptom due to tissue damage from PKD. Nocturia and dysuria are not typical manifestations of PKD. Constipation is not directly associated with PKD. Therefore, the correct choices are flank pain and increased abdominal girth, making option D the correct answer.

4. The nurse is preparing to give a dose of oral clindamycin (Cleocin) to a patient being treated for a skin infection caused by Staphylococcus aureus. The patient has experienced nausea after several doses. What should the nurse do next?

• A. Administer the next dose when the patient has an empty stomach.
• B. Hold the next dose and contact the patient’s provider.
• C. Instruct the patient to take the next dose with a full glass of water.
• D. Request an order for an antacid to give along with the next dose.

Correct answer: C

Rationale: The correct action for the nurse to take next is to instruct the patient to take the next dose of clindamycin with a full glass of water. This is important to minimize gastrointestinal (GI) irritation such as nausea, vomiting, and stomatitis that the patient has been experiencing. Administering the medication on an empty stomach would likely worsen the GI upset. Holding the next dose and contacting the provider is not necessary at this point unless symptoms persist or worsen. Additionally, requesting an antacid is not indicated as the primary intervention for managing the nausea related to clindamycin.

5. A client with chronic renal failure is being treated with sodium polystyrene sulfonate (Kayexalate). The nurse should monitor the client for which of the following?

• A. Hyponatremia.
• B. Hypokalemia.
• C. Hyperkalemia.
• D. Hypocalcemia.

Correct answer: C

Rationale: The correct answer is C: Hyperkalemia. Sodium polystyrene sulfonate (Kayexalate) is used to treat high potassium levels (hyperkalemia) by exchanging sodium ions for potassium ions in the large intestine, which is then eliminated through the feces. Therefore, the nurse should monitor the client for changes in potassium levels to ensure the effectiveness of the treatment. Choices A, B, and D are incorrect because sodium polystyrene sulfonate (Kayexalate) is not associated with causing hyponatremia, hypokalemia, or hypocalcemia.

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