Nursing Elites

1. An elderly male client is admitted to the urology unit with acute renal failure due to a postrenal obstruction. Which question best assists the nurse in obtaining relevant historical data?

• A. Have you had any difficulty starting your urinary stream?
• B. Do you have a history of kidney stones?
• C. How much fluid do you drink daily?
• D. Have you had any previous urinary tract infections?

Correct answer: A

Rationale: The correct answer is A: 'Have you had any difficulty starting your urinary stream?' This question is the most relevant as difficulty starting urination can indicate an obstruction, which aligns with the client's current condition of postrenal obstruction causing acute renal failure. Choice B is incorrect as a history of kidney stones may not be directly related to the current obstruction. Choice C, asking about daily fluid intake, is not specific to the current issue of postrenal obstruction. Choice D inquires about previous urinary tract infections, which are not directly related to the current acute renal failure caused by postrenal obstruction.

2. A client with newly diagnosed peptic ulcer disease is being taught about lifestyle modifications. Which client statement indicates that further teaching is needed?

• A. ‘I should avoid eating spicy foods to prevent irritation of my ulcer.’
• B. ‘I should take my antacids regularly, even if I don’t have symptoms.’
• C. ‘I should avoid smoking to prevent exacerbation of my symptoms.’
• D. ‘I should avoid drinking alcohol to prevent irritation of my ulcer.’

Correct answer: D

Rationale: The corrected question assesses the client's understanding of lifestyle modifications for peptic ulcer disease. Choice D, 'I should avoid drinking alcohol to prevent irritation of my ulcer,' is the correct answer. This statement demonstrates that the client has a good grasp of the teaching provided, as alcohol can indeed irritate peptic ulcers. Choices A, B, and C are all accurate statements that reflect appropriate understanding of managing peptic ulcer disease and do not indicate a need for further teaching.

3. The nurse is assessing a client with left-sided heart failure. Which finding requires immediate intervention?

• A. Shortness of breath
• B. Jugular venous distention
• C. Crackles in the lungs
• D. Peripheral edema

Correct answer: C

Rationale: Crackles in the lungs indicate pulmonary congestion in a client with left-sided heart failure and require immediate intervention to prevent respiratory failure. Crackles suggest fluid accumulation in the lungs, leading to impaired gas exchange and potentially respiratory distress. Shortness of breath, jugular venous distention, and peripheral edema are common manifestations of heart failure but do not directly indicate acute respiratory compromise like crackles in the lungs do.

4. While removing staples from a male client's postoperative wound site, the nurse observes that the client's eyes are closed and his face and hands are clenched. The client states, 'I just hate having staples removed.' After acknowledging the client's anxiety, what action should the nurse implement?

• A. Attempt to distract the client with general conversation
• B. Administer a pain medication
• C. Continue with the procedure while reassuring the client
• D. Stop the procedure and notify the healthcare provider

Correct answer: A

Rationale: In this situation, the nurse should attempt to distract the client with general conversation. Distracting the client can help reduce anxiety and make the procedure less stressful. Administering pain medication (choice B) is not appropriate as the client's discomfort is related to anxiety, not physical pain. Continuing with the procedure while reassuring the client (choice C) may not address the client's anxiety effectively. Stopping the procedure and notifying the healthcare provider (choice D) is not necessary at this point since the client's anxiety can be managed by attempting to distract him.

5. A client with a history of coronary artery disease (CAD) is admitted with chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

• A. Electrocardiogram (ECG)
• B. Chest X-ray
• C. Arterial blood gases (ABGs)
• D. Echocardiogram

Correct answer: A

Rationale: The correct answer is A: Electrocardiogram (ECG). An electrocardiogram should be performed first to assess for cardiac ischemia in a client with a history of CAD and chest pain. An ECG provides immediate information about the heart's electrical activity, helping to identify signs of ischemia or a heart attack. While other diagnostic tests like chest X-ray, arterial blood gases, and echocardiogram may also be necessary in the evaluation of chest pain, they do not provide the initial direct assessment of cardiac ischemia that an ECG does.

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