Nursing Elites

1. A client has pyelonephritis and expresses embarrassment about discussing symptoms. How should the nurse respond?

• A. Assure the client that their symptoms will be kept confidential.
• B. Acknowledge the client's discomfort and avoid discussing elimination topics.
• C. Encourage the use of familiar language and assure the client they can take their time.
• D. Offer the client a nurse of the same gender to provide care.

Correct answer: C

Rationale: When a client expresses embarrassment or discomfort in discussing symptoms related to sensitive topics like elimination and the genitourinary area, the nurse should respond by encouraging the client to use words they are comfortable with. This helps the client feel more at ease and opens up communication. Offering a nurse of the same gender may not address the client's discomfort with discussing symptoms. Assuring confidentiality is important, but it should not be promised in a way that may not be fulfilled. Avoiding the topic of elimination entirely does not address the client's feelings or promote effective communication.

2. A young adult client, admitted to the Emergency Department following a motor vehicle collision, is transfused with 4 units of PRBCs (packed red blood cells). The client's pretransfusion hematocrit is 17%. Which hematocrit value should the nurse expect the client to have after all the PRBCs have been transfused?

• A. 0.19
• B. 0.09
• C. 0.39
• D. 0.29

Correct answer: D

Rationale: The expected increase in hematocrit after transfusion is approximately 3% per unit of PRBCs. Since the client received 4 units, the expected increase would be 4 x 3% = 12%. Therefore, adding this to the pretransfusion hematocrit of 17% would result in an expected post-transfusion hematocrit of 29%. Choice A (0.19) is incorrect as it doesn't consider the incremental increase per unit of PRBCs. Choices B (0.09) and C (0.39) are also incorrect as they do not align with the expected increase in hematocrit following the transfusion of 4 units of PRBCs.

3. A client's laboratory findings indicate elevations in thyroxine and triiodothyronine hormones. The nurse suspects that the client may have hyperthyroidism. Which assessment finding is most often associated with hyperthyroidism?

• A. Periorbital edema.
• B. Atrophied thyroid gland.
• C. Increased pulse rate.
• D. Diarrhea stools.

Correct answer: C

Rationale: Increased pulse rate is commonly associated with hyperthyroidism due to the increased metabolic rate. Periorbital edema (Choice A) is more commonly associated with conditions like nephrotic syndrome or heart failure, not hyperthyroidism. Atrophied thyroid gland (Choice B) is not typically an assessment finding for hyperthyroidism as the gland is usually enlarged in this condition. Diarrhea stools (Choice D) can occur in hyperthyroidism, but it is not the most common assessment finding associated with the condition.

4. 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.

5. A client who has undergone abdominal surgery calls the nurse and reports that she just felt 'something give way' in the abdominal incision. The nurse checks the incision and notes the presence of wound dehiscence. The nurse immediately:

• A. Contacts the physician
• B. Documents the findings
• C. Places the client in a supine position with the legs flat
• D. Covers the abdominal wound with a sterile dressing moistened with sterile saline solution

Correct answer: D

Rationale: In the scenario described, the presence of wound dehiscence indicates a separation of the layers of the surgical incision. The immediate priority for the nurse is to cover the abdominal wound with a sterile dressing moistened with sterile saline solution. This helps to protect the wound from contamination and promotes a moist environment conducive to healing. Contacting the physician (Choice A) is important, but the initial action should be to address the wound. Documenting the findings (Choice B) is necessary but not the immediate priority. Placing the client in a supine position with the legs flat (Choice C) is not indicated in this situation as wound dehiscence requires wound care intervention.

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