Nursing Elites

1. What is an expected outcome when a client is receiving an IV administration of furosemide?

• A. Increased blood pressure.
• B. Increased urine output.
• C. Decreased pain.
• D. Decreased premature ventricular contractions.

Correct answer: B

Rationale: The correct answer is B: Increased urine output. Furosemide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle in the kidneys, leading to increased urine production. This diuretic effect helps to reduce fluid volume in the body, making it an expected outcome when a client is receiving furosemide. Choice A, increased blood pressure, is incorrect because furosemide typically causes a decrease in blood pressure due to its diuretic effect. Choice C, decreased pain, and choice D, decreased premature ventricular contractions, are unrelated to the pharmacological action of furosemide.

2. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

3. A client has a long history of hypertension. Which category of medication would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

• A. Antibiotic
• B. Histamine blocker
• C. Bronchodilator
• D. Angiotensin-converting enzyme (ACE) inhibitor

Correct answer: D

Rationale: The correct answer is D, Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By blocking this conversion, ACE inhibitors promote vasodilation and improve perfusion to the kidneys. Additionally, ACE inhibitors block the breakdown of bradykinin and prostaglandin, further contributing to vasodilation. They also lead to increased renin and decreased aldosterone levels. These effects help in reducing blood pressure and protecting the kidneys in clients with hypertension. Antibiotics are used to fight infections, histamine blockers reduce inflammation, and bronchodilators widen the bronchi, none of which address the underlying processes involved in slowing the progression of chronic kidney disease (CKD) in hypertensive clients.

4. A client with overflow incontinence needs assistance with elimination. What intervention should the nurse include in the plan of care?

• A. Stroke the medial aspect of the thigh.
• B. Use intermittent catheterization.
• C. Provide digital anal stimulation.
• D. Use the Valsalva maneuver.

Correct answer: D

Rationale: In clients with overflow incontinence, the voiding reflex arc is impaired. The Valsalva maneuver, which involves holding the breath and bearing down as if to defecate, can help initiate voiding by applying mechanical pressure. Options A and C (stroking the thigh or anal stimulation) rely on an intact reflex arc to trigger elimination and are not effective for clients with overflow incontinence. Intermittent catheterization (Option B) is a last resort due to the high risk of infection and should only be considered if other interventions fail.

5. A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

• A. Encourage the client to drink more fluids.
• B. Contact the provider and recommend a low-sodium diet.
• C. Prepare to administer an intravenous diuretic.
• D. Obtain a suction device and implement seizure precautions.

Correct answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

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