Nursing Elites

1. An emergency department nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question should the nurse ask first?

• A. Are you drinking plenty of water?
• B. What medications are you taking?
• C. Have you tried laxatives or enemas?
• D. Has this type of thing ever happened before?

Correct answer: B

Rationale: In this scenario, the client's symptoms of dry mouth, constipation, and inability to void are indicative of anticholinergic side effects, which can be caused by medications like propantheline (Pro-Banthine) commonly used to treat incontinence. The first question the nurse should ask is about the client's medications to determine if they are taking anticholinergic drugs. This information is crucial as it can help differentiate between a simple side effect or a potential overdose. Asking about water intake (Choice A) may be relevant later but is not the priority in this situation. Questioning about laxatives or enemas (Choice C) and past occurrences (Choice D) are not as pertinent initially as identifying the client's current medication status.

2. A client who underwent surgery and experienced significant blood loss is being cared for by a nurse. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)

• A. Urine output of 100 mL in 4 hours
• B. Large amount of sediment in the urine
• C. A & B
• D. Amber, odorless urine

Correct answer: C

Rationale: The nurse must monitor for signs of acute kidney injury in a postoperative client who had major blood loss. Low urine output, presence of sediment in the urine, and low blood pressure should raise concerns and be reported to the healthcare provider promptly. Postoperatively, assessing urine characteristics is crucial. Sediment, hematuria, and urine output less than 0.5 mL/kg/hour for 3 to 4 hours should be reported. While a urine output of 100 mL in 4 hours is low, it should be compared to the recommended 0.5 mL/kg/hour over a longer period. Perfusion to the kidneys is a priority, hence the importance of addressing low blood pressure. Amber, odorless urine is considered normal and does not indicate an immediate concern for acute kidney injury, unlike low urine output and presence of sediment.

3. The healthcare professional is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The healthcare professional will request an order for

• A. a decreased dose of TMP-SMX.
• B. a different antibiotic.
• C. an increased dose of warfarin.
• D. coagulation studies.

Correct answer: D

Rationale: Sulfonamides, like trimethoprim-sulfamethoxazole (TMP-SMX), can potentiate the anticoagulant effects of warfarin (Coumadin). To monitor the patient's response and prevent adverse effects, the healthcare professional should request coagulation studies, such as International Normalized Ratio (INR) levels. Choosing a decreased dose of TMP-SMX would not address the potential drug interaction between TMP-SMX and warfarin. Opting for a different antibiotic is not necessary if the interaction can be managed by monitoring. Increasing the dose of warfarin without monitoring could lead to excessive anticoagulation and adverse events, so it's not the appropriate action in this scenario.

4. Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infections?

• A. Sulfonamides are bactericidal.
• B. Sulfonamides are synthetic compounds.
• C. Sulfonamides have antifungal and antiviral properties.
• D. Sulfonamides increase bacterial synthesis of folic acid.

Correct answer: B

Rationale: The characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infections is that sulfonamides are synthetic compounds, not derived from biologic substances. Choice A is incorrect because sulfonamides are bacteriostatic, not bactericidal. Choice C is incorrect because sulfonamides do not have antifungal and antiviral properties. Choice D is incorrect because sulfonamides act by inhibiting bacterial synthesis of folic acid, not increasing it.

5. The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:

• A. Perform the procedure safely and correctly.
• B. Critique the nurse's performance of the procedure.
• C. Explain all steps of the procedure correctly.
• D. Correctly answer a post-test about the procedure.

Correct answer: A

Rationale: The best indicator of learning is the ability to perform the procedure safely and correctly, demonstrating skill acquisition. Choice A is correct because the client's ability to perform the insulin self-injection safely and correctly shows practical understanding and application of the skill. Choice B is incorrect because critiquing the nurse's performance does not necessarily demonstrate the client's ability to carry out the procedure themselves. Choice C is incorrect as merely explaining the steps verbally does not confirm the client's practical execution of the task. Choice D is also incorrect as answering a post-test does not directly assess the client's ability to physically perform the insulin self-injection.

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