Nursing Elites

1. The client is scheduled to begin continuous ambulatory peritoneal dialysis (CAPD). Which of the following statements by the client indicates that more teaching is required?

• A. I will need to limit my intake of protein.
• B. I can skip a dialysis session if I feel tired.
• C. I should increase my intake of potassium-rich foods.
• D. I can eat whatever I want, as long as I take my medications.

Correct answer: B

Rationale: The correct answer is B. Skipping a dialysis session can lead to serious complications as it disrupts the treatment schedule and can result in the accumulation of waste products and fluid in the body. The client must understand the importance of adhering to the prescribed dialysis regimen to maintain optimal health. Choices A, C, and D are incorrect because limiting protein intake, increasing potassium-rich foods, and taking medications do not pose the same risk as skipping dialysis sessions. These aspects are important in the management of peritoneal dialysis but do not outweigh the critical need for regular dialysis sessions to prevent complications.

2. A healthcare professional is reading the chest x-ray report of a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The healthcare professional interprets that the tube is positioned above:

• A. The first tracheal cartilaginous ring
• B. The point where the larynx connects to the trachea
• C. The bifurcation of the right and left main stem bronchi
• D. The area connecting the oropharynx to the laryngopharynx

Correct answer: C

Rationale: The carina is a cartilaginous ridge that separates the openings of the two main stem (right and left) bronchi. If an endotracheal tube is inserted past the carina, the tube will enter the right main stem bronchus due to the natural curvature of the airway. This positioning is dangerous as only the right lung will be ventilated. It can be identified as only the right lung will have breath sounds and rise and fall with ventilation. Choices A, B, and D are incorrect as they do not relate to the specific anatomical landmark mentioned in the scenario.

3. The nurse is caring for a client who is postoperative for a femoral head fracture repair. Which intervention(s) should the nurse plan to administer for deep vein thrombosis prophylaxis?

• A. Pneumatic compression devices
• B. Incentive spirometry
• C. Assisted ambulation
• D. Calf-pump exercises

Correct answer: A

Rationale: The correct intervention for deep vein thrombosis prophylaxis in a postoperative client with a femoral head fracture repair is the use of pneumatic compression devices. These devices help prevent stasis in the lower extremities by promoting venous return through intermittent compression. Incentive spirometry is used to prevent respiratory complications by promoting lung expansion and clearing secretions, not for DVT prophylaxis. Assisted ambulation and calf-pump exercises are beneficial for promoting circulation and preventing DVT, but pneumatic compression devices are more effective in this specific postoperative scenario.

4. A client who is receiving chemotherapy asks the nurse, 'Why is so much of my hair falling out each day?' Which response by the nurse best explains the reason for alopecia?

• A. 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.'
• B. 'Alopecia is a common side effect you will experience during long-term steroid therapy.'
• C. 'Your hair will grow back completely after your course of chemotherapy is completed.'
• D. 'The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss.'

Correct answer: A

Rationale: The correct answer is A: 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.' Chemotherapy targets rapidly dividing cells, which include not only cancer cells but also healthy cells like those in hair follicles. This leads to alopecia (hair loss) as a common side effect. Choice B is incorrect as alopecia is primarily associated with chemotherapy and not long-term steroid therapy. Choice C is incorrect because while hair may grow back after chemotherapy, it may not always be to the same extent or thickness. Choice D is incorrect as chemotherapy-induced hair loss is often temporary and reversible, not permanent alterations in hair follicles.

5. A client is vomiting. For which acid-base imbalance does the nurse assess the client?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: B

Rationale: In a client who is vomiting, the loss of gastric fluid containing hydrochloric acid can lead to metabolic alkalosis. Metabolic alkalosis is caused by the loss of acids such as hydrochloric acid from the body. Therefore, in this scenario, the nurse should assess the client for metabolic alkalosis. Choices A, C, and D are incorrect because vomiting does not typically lead to metabolic acidosis, respiratory acidosis, or respiratory alkalosis.

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