Nursing Elites

1. Which clients are at risk for kidney problems? (Select all that apply.)

• A. Clients taking synthetic creatine supplements
• B. Clients taking metformin for diabetes mellitus
• C. Clients taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain
• D. Clients taking prenatal vitamins and using albuterol nebulizers

Correct answer: A

Rationale: Clients who take synthetic creatine supplements, metformin, and high-dose or long-term NSAIDs are at risk for kidney dysfunction. Synthetic creatine supplements can cause kidney damage, metformin may rarely cause lactic acidosis leading to renal impairment, and high-dose NSAIDs can lead to acute kidney injury. Prenatal vitamins and albuterol nebulizers are not known to significantly impact kidney function, thus do not pose a risk for kidney problems.

2. What should the nurse do before an echocardiogram for a client who has had a myocardial infarction?

• A. Ensuring no food or drink for 4 hours before the procedure
• B. Obtaining informed consent from the client
• C. Assessing for any history of iodine or shellfish allergies
• D. Informing the client about the painless nature and duration of the procedure

Correct answer: D

Rationale: The correct answer is to inform the client that the echocardiogram is a painless procedure that usually takes 30 to 60 minutes to complete. Echocardiography is a noninvasive, risk-free, and pain-free test that uses ultrasound to evaluate the heart's structure and motion. There is no need for special preparation before the procedure. Choices A, B, and C are incorrect because imposing nothing-by-mouth status, obtaining informed consent, and assessing for allergies to iodine or shellfish are not necessary steps before an echocardiogram.

3. For a client with peripheral vascular disease (PVD) of the lower extremities who is trying to manage their condition well, which routine should the nurse evaluate as appropriate?

• A. Resting with the legs elevated above the level of the heart.
• B. Walking slowly but steadily for 30 minutes twice a day.
• C. Minimizing activity.
• D. Wearing antiembolism stockings at all times when out of bed.

Correct answer: B

Rationale: The correct answer is B. Walking slowly but steadily for 30 minutes twice a day is appropriate for clients with PVD as it helps stimulate collateral circulation and improve blood flow. Choice A is incorrect because while elevating the legs can help with symptoms temporarily, it is not as effective as walking for improving circulation. Choice C, minimizing activity, is not recommended as it can lead to further deconditioning and worsen symptoms. Choice D, wearing antiembolism stockings, is not specifically indicated for PVD and may not address the underlying circulation issues.

4. A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

• A. Encourage the client to drink more fluids.
• B. Contact the provider and recommend a low-sodium diet.
• C. Prepare to administer an intravenous diuretic.
• D. Obtain a suction device and implement seizure precautions.

Correct answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

5. The client with chronic renal failure is being taught about dietary restrictions by the nurse. Which of the following food items should the client avoid?

• A. Apples
• B. Bananas
• C. Chicken
• D. Rice

Correct answer: B

Rationale: The correct answer is B: Bananas. Bananas are high in potassium, which should be limited in clients with chronic renal failure to prevent hyperkalemia. Apples (choice A), chicken (choice C), and rice (choice D) are not typically restricted in clients with chronic renal failure. Apples and rice are lower in potassium, while chicken is a good source of lean protein, which is usually encouraged in these clients to meet their protein needs without excess potassium intake.

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