Nursing Elites

1. The nurse is planning care for an older adult client who experienced a cerebrovascular accident several weeks ago. The client has expressive aphasia and often becomes frustrated with the nursing staff. Which intervention should the nurse implement?

• A. Teach the client the use of basic sign language
• B. Speak slowly to the client
• C. Encourage the client's use of picture charts
• D. Ask the client simple questions

Correct answer: C

Rationale: Encouraging the client's use of picture charts is the most appropriate intervention for a client with expressive aphasia. Picture charts provide visual cues that can aid in communication and reduce frustration for the client. This intervention can help the client express their needs and thoughts effectively. Teaching sign language (Choice A) may be challenging and not as practical in this situation as it may not address the specific communication barriers caused by expressive aphasia. Speaking slowly (Choice B) may not fully address the communication difficulties associated with expressive aphasia. Asking simple questions (Choice D) may not be effective as the client may have difficulty understanding and responding due to the nature of expressive aphasia.

2. 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.

3. The client with chronic renal failure who is on a low-sodium diet should avoid which of the following foods?

• A. Fresh fruits.
• B. Canned soups.
• C. Lean meats.
• D. Whole grain bread.

Correct answer: B

Rationale: Canned soups are high in sodium, which can lead to fluid retention and hypertension in clients with chronic renal failure who are on a low-sodium diet. Fresh fruits, lean meats, and whole grain bread are generally lower in sodium and can be included in a low-sodium diet. Lean meats provide essential protein, fresh fruits offer vitamins and minerals, and whole grain bread provides fiber, making them suitable choices for individuals with chronic renal failure.

4. The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?

• A. Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved.
• B. If diarrhea occurs, stop taking the drug immediately and contact your provider.
• C. Stop taking the drug and notify your provider if you develop a rash while taking this drug.
• D. You may save any unused antibiotic to use if your symptoms recur.

Correct answer: C

Rationale: Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.

5. The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)

• A. Man with prostate cancer
• B. Woman with blood clots in the urinary tract
• C. Client with ureterolithiasis
• D. All of the above

Correct answer: D

Rationale: Post-renal acute kidney injury (AKI) occurs due to urine flow obstruction, which can result from conditions such as prostate cancer, blood clots in the urinary tract, and ureterolithiasis (kidney stones). Severe burns would lead to pre-renal AKI by reducing blood flow to the kidneys. Lupus would cause intrarenal AKI by affecting the kidney tissue directly. Therefore, options A, B, and C are correct choices for clients at risk for post-renal AKI, making option D the correct answer.

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