Nursing Elites

1. Which information about mammograms is most important to provide a post-menopausal female client?

• A. Breast self-examinations are not necessary if annual mammograms are obtained.
• B. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron.
• C. Yearly mammograms should be done regardless of previous normal screenings.
• D. Women at high risk should have annual routine and ultrasound mammograms.

Correct answer: C

Rationale: The most important information to provide a post-menopausal female client regarding mammograms is that yearly mammograms should be done regardless of previous normal screenings. It is crucial for post-menopausal women to continue regular mammograms as they are at a higher risk for breast cancer. Option A is incorrect as breast self-examinations are still recommended in addition to mammograms. Option B is not the most important information compared to the importance of regular mammograms. Option D is not the most important advice for all post-menopausal females but specifically for those at high risk, indicating a more targeted approach.

2. After three days of persistent epigastric pain, a female client presents to the clinic. She has been taking oral antacids without relief. Her vital signs are heart rate 122 beats/minute, respirations 16 breaths/minute, oxygen saturation 96%, and blood pressure 116/70. The nurse obtains a 12-lead electrocardiogram (ECG). Which assessment finding is most critical?

• A. Irregular pulse rhythm
• B. Bile-colored emesis
• C. ST elevation in three leads
• D. Complaint of radiating jaw pain

Correct answer: C

Rationale: ST elevation in three leads is a critical finding that suggests myocardial infarction, requiring immediate attention. This finding indicates ischemia or injury to the heart muscle. Choices A, B, and D are not as critical in this scenario. Irregular pulse rhythm may be concerning but does not indicate an immediate life-threatening condition like myocardial infarction. Bile-colored emesis and complaint of radiating jaw pain are relevant but not as indicative of a myocardial infarction as ST elevation in three leads.

3. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patient’s provider to discuss an order for

• A. a low-potassium diet.
• B. intravenous sodium bicarbonate.
• C. Kayexalate and sorbitol.
• D. salt substitutes.

Correct answer: A

Rationale: In the scenario presented, the patient is experiencing mild hyperkalemia with a potassium level of 5.4 mEq/L. The appropriate intervention for mild hyperkalemia is a low-potassium diet to restrict potassium intake. This helps in managing and preventing further elevation of potassium levels. Intravenous sodium bicarbonate is not indicated as the patient's sodium level is normal at 140 mEq/L. Kayexalate, a cation-exchange resin, is typically used for severe hyperkalemia to promote potassium excretion. Salt substitutes, which often contain potassium chloride, should be avoided in patients with hyperkalemia as they can exacerbate the condition by increasing potassium levels further.

4. 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.

5. A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.)

• A. Urge incontinence involves a post-void residual volume less than 50 mL.
• B. Stress incontinence occurs due to weak pelvic floor muscles.
• C. Stress incontinence usually occurs in people with dementia.
• D. Urge incontinence can be managed by increasing fluid intake.

Correct answer: B

Rationale: The correct statement to include in the education about urge incontinence and stress incontinence is choice B. Stress incontinence occurs due to weak pelvic floor muscles or urethral sphincter, leading to the inability to tighten the urethra sufficiently to overcome increased detrusor pressure. This condition is common after childbirth when pelvic muscles are stretched and weakened. Urge incontinence, on the other hand, is characterized by the inability to suppress the contraction signal from the detrusor muscle. It is often associated with abnormal detrusor contractions, which can be due to neurological abnormalities rather than post-void residual volume. Choice A is incorrect because urge incontinence is not defined by post-void residual volume. Choice C is incorrect as stress incontinence is not usually linked to dementia. Choice D is incorrect because increasing fluid intake is not a management strategy for urge incontinence.

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