Nursing Elites

1. The client has been receiving peritoneal dialysis. The nurse should assess the client for which of the following complications that is most likely to occur?

• A. Electrolyte imbalance
• B. Peritonitis
• C. Infection
• D. Hyperglycemia

Correct answer: B

Rationale: Peritonitis is the most likely complication to occur in clients receiving peritoneal dialysis due to the risk of infection. Peritonitis is a serious inflammation of the peritoneum lining the abdominal cavity, commonly caused by infection. While electrolyte imbalance and hyperglycemia are possible complications in some cases, peritonitis poses a more immediate and severe threat to the client's health. Infection is a general term that can encompass peritonitis but is not as specific as directly identifying peritonitis as the primary concern in this scenario.

2. The patient is receiving a high dose of intravenous azithromycin to treat an infection and taking acetaminophen for pain. The nurse should expect to review which lab values when monitoring for this drug’s side effects?

• A. Complete blood counts
• B. Electrolytes
• C. Liver enzymes
• D. Urinalysis

Correct answer: C

Rationale: When a patient is receiving a high dose of intravenous azithromycin, which is a macrolide antibiotic, in combination with acetaminophen, a potentially hepatotoxic drug, the nurse should monitor liver enzymes. High doses of macrolides when taken with hepatotoxic drugs like acetaminophen can lead to hepatotoxicity. Reviewing liver enzymes helps in early detection of liver damage. Complete blood counts (Choice A) are not typically affected by azithromycin or acetaminophen. Electrolytes (Choice B) are not directly impacted by these medications. Urinalysis (Choice D) is not specifically indicated for monitoring the side effects of azithromycin and acetaminophen combination therapy.

3. Upon arrival of a client transferred to the surgical unit, what should the nurse plan to do first?

• A. Assess the patency of the airway
• B. Check tubes and drains for patency
• C. Check the dressing for bleeding
• D. Assess the vital signs to compare them with preoperative measurements

Correct answer: A

Rationale: The initial action for the nurse upon the arrival of a client to the surgical unit is to assess the patency of the airway. This step takes priority to ensure that the client has a clear airway for adequate breathing. Checking tubes and drains for patency, inspecting the dressing for bleeding, and assessing vital signs to compare with preoperative measurements are important subsequent steps in the assessment process. However, ensuring the airway is patent is the immediate priority to maintain the client's respiratory function and overall well-being.

4. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

5. When planning activities for a socialization group for older residents of a long-term facility, what information would be most useful for the nurse?

• A. The length of time each resident has resided at the facility.
• B. A brief description of each resident's family life.
• C. The age of each resident.
• D. The usual activity patterns of each resident.

Correct answer: D

Rationale: The most useful information for the nurse when planning activities for a socialization group for older residents of a long-term facility would be the usual activity patterns of each resident. An older person's level of activity is a determining factor in adjustment to aging, as described by the Activity Theory of Aging. By understanding the usual activity patterns of each resident, the nurse can tailor activities that cater to their interests and abilities, promoting social engagement and overall well-being. The other options, such as the length of time residing at the facility, a brief description of family life, or the age of each resident, may provide some insights but do not directly relate to planning activities that support adjustment to aging and socialization within the group.

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