Nursing Elites

1. The client with chronic renal failure is on a fluid restriction. Which of the following statements by the client indicates that the teaching has been effective?

• A. I will limit my fluid intake to prevent fluid overload.
• B. I can drink as much fluid as I want as long as I take my medication.
• C. I will skip dialysis sessions if I feel tired.
• D. I will limit my fluid intake to 1 liter per day.

Correct answer: A

Rationale: Choice A is the correct answer because it demonstrates the client's understanding of the need to limit fluid intake to prevent fluid overload, which is crucial in managing chronic renal failure. Adequate fluid restriction is essential to prevent complications such as fluid overload and electrolyte imbalances. Choice B is incorrect as it promotes excessive fluid intake, which can worsen the client's condition by putting additional stress on the kidneys. Choice C is incorrect as skipping dialysis sessions can lead to a buildup of toxins in the body, worsening renal failure and potentially leading to life-threatening complications. Choice D is incorrect because limiting fluid intake to a specific volume may not be appropriate for all clients and can vary depending on individual needs, medical condition, and healthcare provider recommendations.

2. What types of medications should the healthcare provider expect to administer to a client during an acute respiratory distress episode?

• A. Vasodilators and hormones.
• B. Analgesics and sedatives.
• C. Anticoagulants and expectorants.
• D. Bronchodilators and steroids.

Correct answer: D

Rationale: During an acute respiratory distress episode, the priority is to widen air passages, increase air space, and reduce alveolar membrane inflammation. Therefore, the client would likely require bronchodilators to open up the airways and steroids to reduce inflammation. Vasodilators and hormones (Choice A) are not typically indicated in this situation. Analgesics and sedatives (Choice B) may be used for pain management and anxiety but are not primary treatments for respiratory distress. Anticoagulants and expectorants (Choice C) are not the main medications used during an acute respiratory distress episode and may not address the immediate needs of the client.

3. A serum phenytoin determination is prescribed for a client with a seizure disorder who is taking phenytoin (Dilantin). Which result indicates that the prescribed dose of phenytoin is therapeutic?

• A. 3 mcg/mL
• B. 8 mcg/mL
• C. 16 mcg/mL
• D. 28 mcg/mL

Correct answer: C

Rationale: The correct answer is 16 mcg/mL (Choice C). The therapeutic serum phenytoin range is typically 10 to 20 mcg/mL. A level below this range may lead to continued seizure activity, indicating subtherapeutic levels. Choices A, B, and D are below the therapeutic range and would not be considered therapeutic for a client with a seizure disorder on phenytoin therapy.

4. Which of the following is a primary intervention for a patient with sepsis?

• A. Administering antibiotics
• B. Administering IV fluids
• C. Administering antipyretics
• D. Monitoring blood cultures

Correct answer: D

Rationale: Monitoring blood cultures is a primary intervention for a patient with sepsis because it helps identify the causative organism, which is crucial in guiding appropriate antibiotic therapy. Administering antibiotics (Choice A) is important in treating sepsis but is considered a secondary intervention. Administering IV fluids (Choice B) is also crucial for sepsis management to restore perfusion and hemodynamic stability. Administering antipyretics (Choice C) may help reduce fever, but it is not a primary intervention for managing sepsis.

5. A client has been taking oral corticosteroids for the past five days because of seasonal allergies. Which assessment finding is of most concern to the nurse?

• A. White blood count of 10,000/mm³.
• B. Serum glucose of 115 mg/dL.
• C. Purulent sputum.
• D. Excessive hunger.

Correct answer: C

Rationale: The correct answer is C: Purulent sputum. Corticosteroids can suppress the immune system, increasing the risk of infections. Purulent sputum suggests a possible respiratory infection, which can rapidly progress and lead to complications, making it the most concerning finding. Choice A, a white blood count of 10,000/mm³, is within the normal range and not typically a cause for immediate concern. Choice B, a serum glucose level of 115 mg/dL, is also normal and not directly related to corticosteroid use. Choice D, excessive hunger, is a common side effect of corticosteroids but is not as concerning as a sign of infection indicated by purulent sputum.

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