Nursing Elites

1. A client recently diagnosed with chronic kidney disease (CKD) is receiving discharge instructions from a nurse. Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

• A. I need to ask for an antibiotic when scheduling a dental appointment.
• B. I’ll need to check my blood sugar often to prevent hypoglycemia.
• C. The dose of my pain medication may have to be adjusted.
• D. The need to watch for bleeding with anticoagulants.

Correct answer: A

Rationale: The correct statements indicating a proper understanding of the teaching include the need for antibiotics for dental work, the potential need to adjust pain medication doses, and the importance of monitoring blood sugar levels. The statement about watching for bleeding with anticoagulants is not directly related to CKD and discharge instructions for this condition. Therefore, option A is correct, as it addresses relevant concerns for a client with CKD, while the other options are either unrelated or not specifically mentioned in the scenario.

2. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding would the nurse consider an indication of progressive hepatic encephalopathy?

• A. An increase in abdominal girth.
• B. Hypertension and a bounding pulse.
• C. Decreased bowel sounds.
• D. Difficulty in handwriting.

Correct answer: D

Rationale: Difficulty in handwriting is a common early sign of hepatic encephalopathy. Changes in handwriting can indicate progression or reversal of hepatic encephalopathy leading to coma. Choice (A) is a sign of ascites, not hepatic encephalopathy. Hypertension and a bounding pulse (Choice B) are not typically associated with hepatic encephalopathy. Decreased bowel sounds (Choice C) do not directly indicate an increase in serum ammonia level, which is the primary cause of hepatic encephalopathy.

3. Which of the following interventions is most appropriate for a patient with left-sided heart failure?

• A. Administering IV fluids.
• B. Administering oxygen.
• C. Administering diuretics.
• D. Administering antihypertensives.

Correct answer: B

Rationale: Administering oxygen is the most appropriate intervention for a patient with left-sided heart failure because it helps improve oxygenation. In left-sided heart failure, the heart struggles to pump oxygen-rich blood to the body, leading to inadequate oxygen supply to tissues. Administering oxygen can help alleviate symptoms of hypoxia and reduce the workload on the heart. IV fluids (Choice A) may exacerbate heart failure by increasing fluid volume, diuretics (Choice C) are used to reduce fluid overload in heart failure, and antihypertensives (Choice D) are more suitable for managing hypertension, which may be a comorbidity in heart failure but are not the primary intervention for left-sided heart failure.

4. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?

• A. My sodium level changes due to the movement from the blood into the dialysate.
• B. Dialysis works by the movement of wastes from higher to lower concentration.
• C. Extra fluid can be pulled from the blood by osmosis.
• D. The dialysate is similar to blood but without any toxins.

Correct answer: B

Rationale: The correct answer is B because dialysis works by the movement of solutes from an area of higher concentration to an area of lower concentration, which is known as diffusion. The other statements are accurate: A correctly describes the movement of sodium during hemodialysis, C explains the removal of excess fluid by osmosis, and D highlights the purpose of the dialysate in removing toxins from the blood.

5. During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. What action should the nurse take first?

• A. Use a laryngoscope to check for a foreign body lodged in the airway.
• B. Reposition the head to ensure that the airway is properly opened.
• C. Turn the client to the side and administer three back blows.
• D. Perform a finger sweep of the mouth to clear any obstructions.

Correct answer: B

Rationale: The most common reason for inadequate lung aeration during CPR is the incorrect positioning of the head, leading to airway obstruction. Therefore, the initial action should be to reposition the head to open the airway properly and attempt to ventilate again. Using a laryngoscope to check for foreign bodies in the airway (Choice A) is not the first step and could delay crucial interventions. Turning the client to the side and administering back blows (Choice C) is not indicated in this scenario as the focus is on ventilating the lungs. Performing a finger sweep of the mouth (Choice D) is not recommended as it may push obstructions further into the airway during CPR.

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