Nursing Elites

1. A nurse is caring for a client who has chronic kidney disease and reports nausea. The nurse should identify that this client is at risk for which of the following imbalances?

• A. Metabolic alkalosis
• B. Metabolic acidosis
• C. Respiratory alkalosis
• D. Respiratory acidosis

Correct answer: B

Rationale: The correct answer is B: Metabolic acidosis. Clients with chronic kidney disease are at risk for metabolic acidosis because the kidneys are unable to effectively excrete acids, leading to an accumulation of acid in the body. This metabolic imbalance can result in symptoms like nausea. Choices A, C, and D are incorrect. Metabolic alkalosis is not typically associated with chronic kidney disease. Respiratory alkalosis is more commonly seen in conditions such as hyperventilation. Respiratory acidosis, on the other hand, is often linked to conditions affecting the lungs or respiratory system, not primarily kidney disease.

2. What is the best way to assess for fluid overload in a patient with heart failure?

• A. Check daily weight
• B. Check blood pressure
• C. Monitor heart sounds
• D. Assess for jugular vein distention

Correct answer: A

Rationale: The correct answer is to 'Check daily weight.' Monitoring daily weight is the most accurate method to assess for fluid overload in patients with heart failure. Weight gain can indicate fluid retention, a common issue in heart failure patients. Checking blood pressure (Choice B) can provide information about hemodynamic status but may not be as specific for fluid overload as monitoring weight. Monitoring heart sounds (Choice C) can provide information about cardiac function but may not directly assess fluid overload. Assessing for jugular vein distention (Choice D) can be a sign of increased central venous pressure but may not always correlate with fluid overload as accurately as daily weight checks.

3. A nurse is providing teaching to a client who has GERD. Which of the following instructions should the nurse include?

• A. Lie flat for 30 minutes after meals.
• B. Avoid lying down after meals.
• C. Drink hot liquids with meals.
• D. Consume a high-carbohydrate snack at bedtime.

Correct answer: B

Rationale: The correct answer is B: 'Avoid lying down after meals.' This instruction is important for clients with GERD to prevent acid reflux. Lying down after meals can worsen GERD symptoms by allowing stomach acid to flow back into the esophagus. Choices A, C, and D are incorrect. Choice A is incorrect because lying flat after meals can increase the risk of acid reflux. Choice C is incorrect because hot liquids may aggravate GERD symptoms. Choice D is incorrect because consuming a high-carbohydrate snack at bedtime can also trigger acid reflux in individuals with GERD.

4. A nurse is providing dietary teaching to a client who has a new diagnosis of irritable bowel syndrome. Which of the following recommendations should the nurse include?

• A. Consume food high in bran fiber.
• B. Increase intake of milk products.
• C. Sweeten foods with fructose corn syrup.
• D. Increase foods high in gluten.

Correct answer: A

Rationale: The correct recommendation for a client with irritable bowel syndrome is to consume food high in bran fiber. Bran fiber promotes regularity and can help reduce symptoms of IBS. Choices B, C, and D are incorrect because increasing milk products, sweetening foods with fructose corn syrup, and consuming foods high in gluten can exacerbate symptoms of irritable bowel syndrome in some individuals.

5. What is the priority nursing assessment for a patient with chronic kidney disease?

• A. Monitor serum creatinine
• B. Monitor blood pressure
• C. Monitor urine output
• D. Monitor potassium levels

Correct answer: A

Rationale: The correct answer is to monitor serum creatinine. In patients with chronic kidney disease, monitoring serum creatinine is crucial as it reflects kidney function. This assessment helps healthcare providers in evaluating the progression of the disease and adjusting treatment plans accordingly. Monitoring blood pressure (choice B) is essential in managing chronic kidney disease, but monitoring serum creatinine takes precedence. Monitoring urine output (choice C) and potassium levels (choice D) are also important aspects of managing chronic kidney disease, but they are not the priority assessment compared to monitoring serum creatinine.

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