Nursing Elites

1. When preparing a client for intravenous pyelography (IVP), which action by the nurse is most important?

• A. Administering a sedative
• B. Encouraging fluid intake
• C. Administering an oral preparation of radiopaque dye
• D. Questioning the client about allergies to iodine or shellfish

Correct answer: D

Rationale: The most crucial action for the nurse when preparing a client for intravenous pyelography (IVP) is to question the client about allergies to iodine or shellfish. Some IVP dyes contain iodine, and if the client is allergic to iodine or shellfish, they may experience severe allergic reactions such as itching, hives, rash, throat tightness, difficulty breathing, or bronchospasm. Administering a sedative (Choice A) may be needed for relaxation during the procedure, encouraging fluid intake (Choice B) is generally beneficial but not the most crucial for IVP preparation, and administering radiopaque dye (Choice C) should only be done after confirming the client's safety regarding allergies to iodine or shellfish.

2. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mg/dL. What question should the nurse ask first when taking this client’s history?

• A. Have you been taking any aspirin, ibuprofen, or naproxen recently?
• B. Do you have anyone in your family with renal failure?
• C. Have you had a diet that is low in protein recently?
• D. Has a relative had a kidney transplant lately?

Correct answer: A

Rationale: The correct question to ask the client first is about their recent intake of nephrotoxic medications like aspirin, ibuprofen, or naproxen. Elevated serum creatinine and BUN levels indicate possible renal issues, making it crucial to assess potential causes such as medication-induced nephrotoxicity. Inquiring about family history of renal failure or recent kidney transplants would not provide immediate insights into the client's current renal condition. While a diet low in protein could influence BUN levels, it is important to address medication history first due to the acute presentation in the emergency department.

3. A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: D

Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.

4. A client is undergoing hemodialysis. The client’s blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. What actions should the nurse perform to maintain blood pressure? (Select all that apply.)

• A. Adjust the rate of extracorporeal blood flow.
• B. Place the client in the Trendelenburg position.
• C. Administer a 250-mL bolus of normal saline.
• D. All of the above

Correct answer: D

Rationale: During hemodialysis, a drop in blood pressure can occur due to fluid removal. To maintain blood pressure, the nurse should consider adjusting the rate of extracorporeal blood flow to optimize fluid removal without causing hypotension. Placing the client in the Trendelenburg position can help improve venous return and cardiac output. Administering a bolus of normal saline can help increase intravascular volume and support blood pressure. Therefore, all the actions listed in choices A, B, and C are appropriate measures to maintain blood pressure during hemodialysis. Choice D, 'All of the above,' is the correct answer as it encompasses all the relevant actions to address the dropping blood pressure effectively. Choices A, B, and C, when implemented together, can help manage hypotension during hemodialysis.

5. A nurse has a prescription to discontinue a client’s nasogastric tube. The nurse auscultates the client’s bowel sounds, positions the client properly, and flushes the tube with 15 mL of air to clear secretions. The nurse then instructs the client to take a deep breath and:

• A. Exhale during tube removal
• B. Bear down during tube removal
• C. Hold the breath during tube removal
• D. Breathe normally during tube removal

Correct answer: C

Rationale: The correct answer is to instruct the client to hold their breath during tube removal. This is because the airway may be temporarily obstructed during the removal process. By holding their breath, the client can help prevent aspiration or discomfort during the removal of the nasogastric tube. Choices A, B, and D are incorrect because exhaling, bearing down, or breathing normally during tube removal may not provide the necessary protection against aspiration or discomfort that holding the breath does.

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