Nursing Elites

1. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

2. The nurse is monitoring a client who is receiving continuous ambulatory peritoneal dialysis. The nurse should notify the physician of which of the following findings?

• A. Clear dialysate outflow.
• B. Cloudy dialysate outflow.
• C. Decreased urine output.
• D. Increased blood pressure.

Correct answer: B

Rationale: Cloudy dialysate outflow is an indication of peritonitis, a serious complication of peritoneal dialysis that requires immediate medical attention. Clear dialysate outflow is a normal finding indicating proper dialysis function and should not raise concern. Decreased urine output may be expected in a client undergoing dialysis due to the removal of excess fluids from the body. Increased blood pressure is a common complication in clients with kidney disease but is not directly related to cloudy dialysate outflow.

3. A young adult is burned when wearing a shirt that was splashed with lighter fluid and caught on fire while attempting to light a charcoal grill. The client ripped off the shirt immediately, without unbuttoning the sleeves, which caused circumferential burns to both wrists. When the client is admitted, which intervention should the nurse implement first?

• A. Monitor pulse intensity.
• B. Evaluate extremity sensation.
• C. Assess range of motion.
• D. Place sterile bandage on both wrists.

Correct answer: A

Rationale: Monitoring pulse intensity is the priority to ensure circulation is not compromised due to circumferential burns.

4. The patient is taking low-dose erythromycin prophylactically and will start cefaclor for treating an acute infection. The nurse should discuss this with the provider because taking both medications simultaneously can cause which effect?

• A. Decreased effectiveness of cefaclor.
• B. Increased effectiveness of cefaclor.
• C. Decreased effectiveness of erythromycin.
• D. Increased effectiveness of erythromycin.

Correct answer: A

Rationale: When erythromycin and cefaclor are taken together, erythromycin can inhibit the metabolism of cefaclor, leading to elevated cefaclor levels and potentially causing adverse effects. This results in a decrease in the effectiveness of cefaclor. Therefore, the nurse should discuss this potential drug interaction with the provider to consider an alternative treatment or adjust the dosages to prevent complications. Choices B, C, and D are incorrect because the concern lies with the effect on cefaclor when combined with erythromycin, not the effect on erythromycin itself.

5. The client with chronic kidney disease (CKD) is being taught about the necessary sodium restriction in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

• A. I am thrilled that I can continue to eat fast food.
• B. I will cut out bacon with my eggs every morning.
• C. My cooking style will change by not adding salt.
• D. I will probably lose weight by cutting out potato chips.

Correct answer: A

Rationale: Choice A, 'I am thrilled that I can continue to eat fast food,' indicates a lack of understanding as fast food is typically high in sodium, which is detrimental for individuals with CKD. The client should be advised to avoid fast food due to its high sodium content. Choices B, C, and D demonstrate a good understanding of the need for sodium restriction in the diet to prevent complications associated with CKD. Cutting out bacon, avoiding salt in cooking, and eliminating high-sodium snacks like potato chips are all positive steps towards managing CKD.

Similar Questions