Nursing Elites

1. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to

• A. not take a potassium supplement daily.
• B. recognize that abdominal cramping is a common side effect.
• C. report decreased urine output to the provider.
• D. take these medications in the morning.

Correct answer: C

Rationale: When combining a potassium-sparing diuretic like spironolactone with a thiazide diuretic, there is an increased risk of hyperkalemia, especially in patients with poor renal function. Therefore, the patient should be educated to report any decrease in urine output, which could indicate a potential issue with kidney function. Choice A is incorrect because taking additional potassium supplements can further increase the risk of hyperkalemia. Choice B is incorrect as abdominal cramping is not a common side effect of spironolactone. Choice D is incorrect because the timing of medication administration is not directly related to the addition of spironolactone and thiazide diuretic; there is no specific recommendation to take these medications only at bedtime.

2. 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.

3. The client with chronic renal failure is being taught about fluid restrictions by the nurse. Which statement by the client indicates a need for further teaching?

• A. I can drink as much water as I want, as long as I limit my salt intake.
• B. I should limit my fluid intake to prevent fluid overload.
• C. I can skip dialysis sessions if I feel tired.
• D. I can eat whatever I want, as long as I take my medications.

Correct answer: C

Rationale: Choice C is the correct answer because clients with chronic renal failure should not skip dialysis sessions. Skipping dialysis can lead to serious complications and worsen the client's condition. It is crucial for clients to understand the importance of adhering to their dialysis schedule for optimal management of chronic renal failure. Choices A, B, and D are incorrect because they demonstrate understanding of fluid restrictions, the need to limit fluid intake to prevent overload, and the importance of medication compliance, respectively. These statements show appropriate knowledge and do not indicate a need for further teaching.

4. A client has a chest drainage system in place. The fluid in the water seal chamber rises and falls during inspiration and expiration. The nurse interprets this finding as an indication that:

• A. The tube is patent
• B. There is probably a kink in the tubing
• C. Suction should be added to the system
• D. The client is retaining airway secretions

Correct answer: A

Rationale: The correct answer is A: 'The tube is patent.' When the fluid in the water seal chamber rises and falls during inspiration and expiration, it indicates that the chest tube is patent, allowing for proper drainage. Choice B is incorrect because a kink in the tubing would obstruct the flow of fluid, leading to abnormal fluctuations in the water seal chamber. Choice C is incorrect as adding suction to the system is not indicated based on the described finding. Choice D is incorrect as the rising and falling of fluid in the water seal chamber is not indicative of the client retaining airway secretions.

5. To reduce the risk of pulmonary complications for a client with ALS, which intervention should the nurse implement?

• A. Perform chest physiotherapy
• B. Teach the client breathing exercises
• C. Initiate passive range of motion exercises
• D. Establish a regular bladder routine

Correct answer: A

Rationale: Performing chest physiotherapy is the most appropriate intervention to reduce the risk of pulmonary complications in clients with ALS. Chest physiotherapy helps mobilize and clear respiratory secretions, improving lung function and reducing the risk of complications such as pneumonia. Teaching breathing exercises (Choice B) may be beneficial for some clients, but chest physiotherapy is more specifically targeted at managing pulmonary issues in ALS. Initiating passive range of motion exercises (Choice C) and establishing a regular bladder routine (Choice D) are important interventions in ALS care but are not directly related to reducing the risk of pulmonary complications.

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