Nursing Elites

1. 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.

2. The nurse is caring for a patient who is ordered to receive PO trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct

• A. dose.
• B. drug.
• C. frequency.
• D. route.

Correct answer: C

Rationale: The correct answer is 'frequency.' Trimethoprim-sulfamethoxazole (TMP-SMX) is typically prescribed to be taken twice daily, not four times a day (QID). The dose, drug, and route are already specified in the order, so the nurse should contact the provider to clarify the frequency of administration to ensure optimal treatment for the urinary tract infection caused by E. coli. Choosing 'dose' is incorrect because the dose of 160/800 is already provided in the order. 'Drug' is incorrect because the medication Trimethoprim-sulfamethoxazole (TMP-SMX) is explicitly stated in the prescription. 'Route' is incorrect as PO (by mouth) is also clearly indicated in the prescription.

3. A client is returning home after arthroscopy of the shoulder. The nurse should tell the client:

• A. To resume full activity the next day
• B. Not to eat or drink anything until the next morning
• C. To keep the shoulder completely immobilized for the rest of the day
• D. To report to the physician the development of fever or redness and heat at the site

Correct answer: D

Rationale: After arthroscopy, it is important for the client to report any signs of infection, such as the development of fever or redness and heat at the site, to the physician promptly. Options A, B, and C are incorrect. The client should not resume full activity the next day as rest and limited movement are usually recommended post-arthroscopy. It is not necessary to withhold food or fluids until the next morning; the client may resume the usual diet immediately unless otherwise instructed. While immobilization may be recommended for a period, keeping the shoulder completely immobilized for the rest of the day is not typically necessary post-arthroscopy.

4. An emergency department nurse assesses a client with kidney trauma and notes that the client’s abdomen is tender and distended, and blood is visible at the urinary meatus. Which prescription should the nurse consult the provider about before implementation?

• A. Assessing vital signs every 15 minutes
• B. Inserting an indwelling urinary catheter
• C. Administering intravenous fluids at 125 mL/hr
• D. Typing and crossmatching for blood products

Correct answer: B

Rationale: In a client with kidney trauma and blood visible at the urinary meatus, inserting a urinary catheter via the urethra should be avoided until further diagnostic studies are completed to prevent potential urethral tears. The nurse should consult the provider about the need for a catheter; if necessary, a suprapubic catheter can be used instead. Assessing vital signs every 15 minutes is important for continuous monitoring of the client's condition. Administering intravenous fluids at 125 mL/hr is crucial to maintain hydration and support kidney function. Typing and crossmatching for blood products is necessary in case the client requires blood transfusion due to potential blood loss from the trauma.

5. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?

• A. Registered nurse who just floated from the surgical unit
• B. Registered nurse who just floated from the dialysis unit
• C. Registered nurse who was assigned the same client yesterday
• D. Licensed practical nurse with 5 years of experience on this floor

Correct answer: C

Rationale: The client is exhibiting symptoms of pericarditis, which can occur with chronic kidney disease. Continuity of care is crucial to assess subtle changes in clients' conditions. Therefore, the registered nurse (RN) who previously cared for this client should be assigned again. Float nurses may lack knowledge of the unit and its clients, potentially leading to oversight of critical details. The licensed practical nurse, while experienced, may not possess the advanced assessment skills and education level of an RN to effectively evaluate and manage pericarditis in this client.

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