Nursing Elites

1. A client is admitted for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). Which breakfast selection by the client indicates effective learning?

• A. Scrambled eggs, bacon, one slice of whole wheat toast with butter and jam.
• B. Oatmeal with butter, artificial sweetener, and strawberries, and 6 ounces of coffee.
• C. Banana pancake with maple syrup, sausage links, half grapefruit, and low-fat milk.
• D. Orange juice, yogurt with berries, cold cereal with milk, bran muffin with margarine.

Correct answer: B

Rationale: The correct answer is B. Oatmeal with butter, artificial sweetener, and strawberries is a suitable choice for a client with type 2 diabetes mellitus and chronic kidney disease as it provides a balanced meal that helps manage blood sugar levels and kidney function. Choice A contains high saturated fats and added sugars from bacon, butter, and jam, which are not ideal for this client. Choice C includes high sugar content from maple syrup and pancake, which can negatively impact blood sugar levels. Choice D contains high sugar content from orange juice and cold cereal, which can lead to blood sugar spikes, not suitable for a client with diabetes and CKD.

2. To reduce the risk of being named in a malpractice lawsuit, which action is most important for the nurse to take?

• A. Adhere consistently to standards of care.
• B. Thoroughly document all client interactions.
• C. Build a good rapport with clients.
• D. Work closely with the healthcare team.

Correct answer: A

Rationale: Adhering consistently to standards of care is crucial for nurses to reduce the risk of being named in a malpractice lawsuit. Following established protocols and guidelines ensures that the care provided is safe and effective. Thoroughly documenting all client interactions is also essential to support the care provided and to have a record of the interventions. Building a good rapport with clients is important for communication and trust but does not directly reduce the risk of malpractice. Working closely with the healthcare team is valuable for collaboration but might not directly impact the risk of malpractice unless it relates to following standards of care.

3. A female client who is admitted to the mental health unit for opiate dependency is receiving clonidine 0.1 mg PO for withdrawal symptoms. The client begins to complain of feeling nervous and tells the nurse that her bones are itching. Which finding should the nurse identify as a contraindication for administering the medication?

• A. Blood pressure 90/76 mm Hg.
• B. Heart rate of 85 bpm.
• C. Respiratory rate of 20 breaths/minute.
• D. Temperature of 99°F (37.2°C).

Correct answer: A

Rationale: Clonidine can lower blood pressure, so a BP of 90/76 mm Hg may indicate that it is unsafe to administer another dose. In this situation, the low blood pressure reading indicates that the client is already experiencing hypotension, which is a common side effect of clonidine. Administering more clonidine could further lower the blood pressure, leading to potential complications. The heart rate, respiratory rate, and temperature are within normal limits and do not serve as contraindications for administering clonidine in this scenario.

4. A client is being treated with an aminoglycoside antibiotic for a serious gram-negative infection. What nursing action should be included in the plan of care to prevent nephrotoxicity?

• A. Monitor serum creatinine levels daily.
• B. Administer the antibiotic over a longer period of time.
• C. Encourage increased fluid intake.
• D. Restrict dietary protein intake.

Correct answer: A

Rationale: Monitoring serum creatinine levels daily is the essential nursing action to prevent nephrotoxicity from aminoglycoside antibiotics. Aminoglycosides can cause kidney damage, so monitoring serum creatinine levels helps in detecting early signs of nephrotoxicity. Administering the antibiotic over a longer period of time (choice B) does not directly prevent nephrotoxicity. Encouraging increased fluid intake (choice C) is a general good practice but not specifically aimed at preventing nephrotoxicity. Restricting dietary protein intake (choice D) is not a direct preventive measure against aminoglycoside-induced nephrotoxicity.

5. The nurse is caring for a client with acute kidney injury (AKI) secondary to gentamicin therapy. The client's serum blood potassium is elevated. Which finding requires immediate action by the nurse?

• A. Anuria for the last 12 hours.
• B. Tachycardia and hypotension.
• C. Decreased urine output.
• D. Elevated blood urea nitrogen (BUN) levels.

Correct answer: A

Rationale: The correct answer is A. Anuria for the last 12 hours. Anuria, the absence of urine output, indicates complete kidney failure and is a medical emergency that requires immediate attention. In acute kidney injury (AKI), the kidneys are unable to filter waste from the blood effectively, leading to a buildup of toxins and electrolyte imbalances like elevated blood potassium levels. Tachycardia and hypotension (choice B) can be seen in AKI but do not reflect the urgency of addressing anuria. Decreased urine output (choice C) is concerning but not as critical as the absence of urine production. Elevated blood urea nitrogen (BUN) levels (choice D) are indicative of kidney dysfunction but do not demand immediate action as anuria does.

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