Nursing Elites

1. What is the most appropriate response when a client wants to discontinue dialysis?

• A. Ask the client why they want to discontinue.
• B. Instruct the client to focus on self-care.
• C. Offer to call the provider to cancel dialysis.
• D. Seek clarification and establish understanding.

Correct answer: D

Rationale: When a client expresses the desire to discontinue dialysis, the most appropriate response is to seek clarification and establish understanding. This approach allows the healthcare provider to comprehend the client's concerns, provide support, and engage in a collaborative decision-making process. Choice A, asking the client why they want to discontinue, can be perceived as confrontational and may not effectively address the underlying reasons. Instructing the client to focus on self-care (Choice B) may overlook the client's autonomy and decision-making capacity. Offering to call the provider to cancel dialysis (Choice C) does not actively involve the client in the decision-making process or address their concerns adequately.

2. A client who is to undergo an exercise stress test is being taught by a nurse. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should eat a large meal 2 hours before the test
• B. I should avoid drinking water before the test
• C. I should stop taking my blood pressure medication
• D. I should report any chest pain during the test

Correct answer: D

Rationale: The correct answer is D: 'I should report any chest pain during the test.' This statement indicates an understanding of the teaching because reporting chest pain during an exercise stress test is crucial as it may signify cardiac distress. Choices A, B, and C are incorrect. Eating a large meal 2 hours before the test is not recommended as it may affect the results. Avoiding drinking water before the test is also not advisable as staying hydrated is important. Stopping blood pressure medication without medical advice can be dangerous, especially before a stress test.

3. What are the signs and symptoms of hyperkalemia and how should it be managed?

• A. Muscle weakness and cardiac arrhythmias; administer calcium gluconate
• B. Confusion and bradycardia; administer insulin and glucose
• C. Fatigue and irregular heart rate; administer diuretics
• D. Nausea and vomiting; administer sodium bicarbonate

Correct answer: A

Rationale: The signs and symptoms of hyperkalemia include muscle weakness and cardiac arrhythmias, making choice A correct. Hyperkalemia can lead to dangerous cardiac effects, and calcium gluconate is used to stabilize the heart by antagonizing the effects of potassium. Choices B, C, and D describe symptoms and interventions that are not typically associated with hyperkalemia. Confusion and bradycardia are not common in hyperkalemia, and insulin and glucose are used in hyperkalemia only under specific circumstances. Fatigue and irregular heart rate are vague symptoms, and diuretics are not the primary treatment for hyperkalemia. Nausea and vomiting are nonspecific symptoms and sodium bicarbonate is not indicated for the management of hyperkalemia.

4. A nurse is preparing to perform a sterile dressing change. Which of the following actions should the nurse take when setting up the sterile field?

• A. Place the cap from the solution sterile side up on a clean surface.
• B. Open the outermost flap of the sterile kit away from the body.
• C. Place the sterile dressing within 1.25 cm (0.5 in) of the edge of the sterile field.
• D. Set up the sterile field 5 cm (2 in) above waist level.

Correct answer: A

Rationale: To maintain the sterility of the field, the nurse should place the cap from the solution sterile side up on a clean surface. This action helps prevent contamination. Choice B is incorrect because opening the outermost flap toward the body increases the risk of introducing contaminants onto the sterile field. Choice C is incorrect as the sterile dressing should be placed at least 2.5 cm (1 in) from the edge of the sterile field to prevent accidental contamination. Choice D is incorrect because setting up the sterile field above waist level could lead to inadvertent contact and compromise the field's sterility.

5. What is the first step in managing a client with delirium?

• A. Administer sedative medication to calm the client
• B. Identify any reversible causes of delirium
• C. Limit environmental stimulation to reduce anxiety
• D. Administer antipsychotic medication to control behavior

Correct answer: B

Rationale: The correct first step in managing a client with delirium is to identify any reversible causes of delirium. This is crucial because addressing the underlying cause can help in resolving delirium more effectively. Administering sedative or antipsychotic medications without addressing the root cause may not be helpful and can even worsen the condition. Limiting environmental stimulation, although important, is not the primary step in managing delirium.

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