Nursing Elites

1. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client’s recent history?

• A. Pyelonephritis
• B. Myocardial infarction
• C. Bladder cancer
• D. Kidney stones

Correct answer: B

Rationale: In pre-renal acute kidney injury, there is a decrease in perfusion to the kidneys. Myocardial infarction can lead to decreased blood flow to the kidneys, causing pre-renal AKI. Pyelonephritis is an intrinsic/intrarenal cause of AKI involving kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI due to urinary flow obstruction, not related to perfusion issues seen in pre-renal AKI.

2. The healthcare provider is assessing the client's use of medications. Which of the following medications may cause a complication with the treatment plan of a client with diabetes?

• A. Aspirin
• B. Steroids
• C. Sulfonylureas
• D. Angiotensin-converting enzyme (ACE) inhibitors

Correct answer: B

Rationale: The correct answer is B: Steroids. Steroids can induce hyperglycemia, complicating diabetes management by raising blood sugar levels. Aspirin is not typically associated with causing complications in diabetic clients. Sulfonylureas are oral antidiabetic medications that can lower blood sugar levels and are commonly used in diabetes management, making them beneficial rather than harmful. Angiotensin-converting enzyme (ACE) inhibitors are medications often prescribed to manage hypertension in diabetic clients and do not typically interfere with diabetes treatment plans.

3. A client has made an appointment for her annual Papanicolaou test (a.k.a. Pap smear). The nurse who schedules the appointment should tell the client that:

• A. The test cannot be performed while the client is menstruating
• B. Vaginal douching is required at least 24 hours before the test
• C. Spicy foods should not be eaten on the day of the test
• D. The test has absolutely no discomfort associated with it

Correct answer: A

Rationale: The correct answer is A. A Pap smear cannot be performed with accurate results during menstruation. Menstrual blood may interfere with the test results. Choice B is incorrect as vaginal douching should be avoided for at least 24 hours before the test to prevent altering the cervical cells. Choice C is incorrect as there is no restriction on spicy foods before a Pap smear. Choice D is incorrect as some women may experience mild discomfort during the test, although it is generally well-tolerated.

4. A client who experienced partial-thickness burns involving over 50% body surface area (BSA) 2 weeks ago has several open wounds and develops watery diarrhea. The client's blood pressure is 82/40 mmHg, and temperature is 96°F (36.6°C). Which action is most important for the nurse to take?

• A. Increase the room temperature.
• B. Assess the oxygen saturation.
• C. Continue to monitor vital signs.
• D. Notify the rapid response team.

Correct answer: D

Rationale: In this scenario, the client is presenting with signs of sepsis, such as hypotension, hypothermia, and a recent history of partial-thickness burns with open wounds. The development of watery diarrhea further raises suspicion for sepsis. With a blood pressure of 82/40 mmHg and a low temperature of 96°F (36.6°C), the nurse should recognize the potential for septic shock. Notifying the rapid response team is crucial in this situation as the client requires immediate intervention and management to prevent deterioration and address the underlying septic process. Increasing the room temperature (Choice A) is not the priority as the low body temperature is likely due to systemic vasodilation and not environmental factors. While assessing oxygen saturation (Choice B) is important, the client's hypotension and hypothermia take precedence. Continuing to monitor vital signs (Choice C) alone is insufficient given the critical condition of the client and the need for prompt action to address the sepsis and potential septic shock.

5. The patient is taking low-dose erythromycin prophylactically and will start cefaclor for treating an acute infection. The nurse should discuss this with the provider because taking both medications simultaneously can cause which effect?

• A. Decreased effectiveness of cefaclor.
• B. Increased effectiveness of cefaclor.
• C. Decreased effectiveness of erythromycin.
• D. Increased effectiveness of erythromycin.

Correct answer: A

Rationale: When erythromycin and cefaclor are taken together, erythromycin can inhibit the metabolism of cefaclor, leading to elevated cefaclor levels and potentially causing adverse effects. This results in a decrease in the effectiveness of cefaclor. Therefore, the nurse should discuss this potential drug interaction with the provider to consider an alternative treatment or adjust the dosages to prevent complications. Choices B, C, and D are incorrect because the concern lies with the effect on cefaclor when combined with erythromycin, not the effect on erythromycin itself.

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