Nursing Elites

1. A client is starting urinary bladder training. Which statement should the nurse include in this client’s teaching?

• A. Use the toilet when you first feel the urge, rather than at specific intervals.
• B. Try to consciously hold your urine until the scheduled toileting time.
• C. Initially try to use the toilet at least every half hour for the first 24 hours.
• D. The toileting interval can be increased once you have been continent for a week.

Correct answer: B

Rationale: In urinary bladder training, the client should be taught to try to consciously hold their urine until the scheduled toileting time. This helps in training the bladder to hold urine for longer periods. Option A is incorrect because the goal is to consciously hold urine, not void immediately. Option C is incorrect as toileting at least every half hour may not promote bladder training. Option D is incorrect as increasing the toileting interval should be based on the client's comfort and progress, not just after being continent for a week.

2. Which food is most important to encourage a client with osteomalacia to include in a daily diet?

• A. Fortified milk and cereals
• B. Citrus fruits and juices
• C. Green leafy vegetables
• D. Red meats and eggs

Correct answer: A

Rationale: The correct answer is A: Fortified milk and cereals. Osteomalacia is a condition caused by a deficiency in vitamin D. Fortified milk and cereals are rich sources of vitamin D, which is essential for managing osteomalacia. Citrus fruits and juices (choice B) are high in vitamin C, but vitamin D is the primary concern for osteomalacia. Green leafy vegetables (choice C) are good sources of various nutrients but not the main focus for managing osteomalacia. Red meats and eggs (choice D) are good sources of protein and other nutrients but are not as critical as fortified milk and cereals for addressing vitamin D deficiency in osteomalacia.

3. The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patient’s admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?

• A. Administer the digoxin and monitor the patient’s electrocardiogram closely.
• B. Hold the digoxin dose and notify the provider of the patient’s lab values.
• C. Request an order for an intravenous bolus of potassium.
• D. Request an order for oral potassium supplements.

Correct answer: B

Rationale: In the scenario presented, the patient has a low serum potassium level, which can predispose the patient to digoxin toxicity. It is essential for the nurse to hold the digoxin dose and promptly notify the healthcare provider of the abnormal lab values. Option A is incorrect because administering digoxin without addressing the low potassium level can potentiate toxicity. Option C is inappropriate as potassium should not be given as an IV bolus, especially in the case of hypokalemia. Option D is incorrect because oral potassium supplements may not be sufficient for rapidly correcting severe hypokalemia in an acute care setting.

4. Which of the following is a key symptom of myocardial infarction (MI)?

• A. Chest pain.
• B. Shortness of breath.
• C. Nausea.
• D. Fatigue.

Correct answer: A

Rationale: The correct answer is A: Chest pain. Chest pain is a hallmark symptom of myocardial infarction (MI) due to inadequate blood flow to the heart muscle. This pain can be severe, crushing, or squeezing, and may radiate to the left arm, jaw, or back. Shortness of breath (choice B), nausea (choice C), and fatigue (choice D) can accompany MI but are not as specific or characteristic as chest pain in diagnosing this condition. Therefore, chest pain is the primary symptom to recognize for suspected MI.

5. What is an ideal goal of treatment set by the nurse in the care plan for a client diagnosed with chronic kidney disease (CKD) to reduce the risk of pulmonary edema?

• A. Maintaining oxygen saturation above 92%
• B. Absence of crackles and wheezes in lung sounds
• C. Maintaining a balanced intake and output
• D. Absence of shortness of breath at rest

Correct answer: C

Rationale: The ideal goal of treatment for a client with chronic kidney disease (CKD) to reduce the risk of pulmonary edema is to maintain a balanced intake and output. This helps in achieving optimal fluid balance, enabling the heart to eject blood effectively without increasing pressure in the left ventricle and pulmonary vessels. While maintaining oxygen saturation above 92% is important for adequate tissue oxygenation, the primary focus in this scenario is fluid balance. Absence of crackles and wheezes in lung sounds is important to assess for pulmonary status, but it is not the primary goal to prevent pulmonary edema specifically. Similarly, absence of shortness of breath at rest is a relevant goal, but the emphasis in CKD management is on fluid balance to prevent pulmonary complications.

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