Nursing Elites

1. A client who just returned from the recovery room after a tonsillectomy and adenoidectomy is restless, and her pulse rate is increased. As the nurse continues the assessment, the client begins to vomit a copious amount of bright-red blood. The immediate nursing action is to:

• A. Notify the surgeon
• B. Continue the assessment
• C. Check the client’s blood pressure
• D. Obtain a flashlight, gauze, and a curved hemostat

Correct answer: A

Rationale: In the scenario described, the client's presentation with bright-red blood vomiting after a tonsillectomy and adenoidectomy is highly concerning for an immediate postoperative hemorrhage, which can be life-threatening. The priority action for the nurse is to notify the surgeon immediately. Prompt communication with the surgeon is vital to ensure swift intervention and appropriate management to address the hemorrhage effectively. Continuing the assessment, checking the client's blood pressure, or obtaining equipment are all secondary actions in this critical situation and would delay the necessary urgent intervention required to manage the hemorrhage effectively.

2. After educating a client with stress incontinence, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?

• A. I will limit my total intake of fluids.
• B. I must avoid drinking alcoholic beverages.
• C. I must avoid drinking caffeinated beverages.
• D. I shall try to lose about 10% of my body weight.

Correct answer: A

Rationale: The correct answer is A. Limiting fluids can worsen stress incontinence by concentrating urine and irritating tissues, leading to increased incontinence. Adequate hydration is important to maintain bladder health and function. Choices B and C are correct as avoiding alcoholic and caffeinated beverages can help reduce bladder irritation. Choice D is also correct as losing about 10% of body weight can help reduce intra-abdominal pressure, which is beneficial in managing stress incontinence.

3. A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse will wedge the catheter to gain information about which of the following?

• A. Cardiac output.
• B. Right atrial blood flow.
• C. Left end-diastolic pressure.
• D. Cardiac index.

Correct answer: C

Rationale: The correct answer is C: Left end-diastolic pressure. Wedging the pulmonary artery catheter allows the nurse to obtain the pulmonary artery wedge pressure, which reflects the left end-diastolic pressure. This pressure is essential in assessing left ventricular function and diagnosing conditions like heart failure. Choices A, B, and D are incorrect because wedging the catheter does not directly provide information about cardiac output, right atrial blood flow, or cardiac index.

4. A 58-year-old client who has been post-menopausal for five years is concerned about the risk for osteoporosis because her mother has the condition. Which information should the nurse offer?

• A. Osteoporosis is a progressive genetic disease with no effective treatment.
• B. Calcium loss from bones can be slowed by increasing calcium intake and exercise.
• C. Estrogen replacement therapy should be started to prevent the progression of osteoporosis.
• D. Low-dose corticosteroid treatment effectively halts the course of osteoporosis.

Correct answer: B

Rationale: Post-menopausal females are at risk for osteoporosis due to the cessation of estrogen secretion. While genetics can play a role, osteoporosis is not solely a genetic disease. Increasing calcium intake, along with vitamin D supplementation and weight-bearing exercise, can help prevent further bone loss by slowing down calcium loss from bones. Estrogen replacement therapy is no longer recommended as a first-line treatment for osteoporosis due to associated risks. Corticosteroid treatment is not typically used as a primary treatment for osteoporosis.

5. The nurse is obtaining a health history from a new client who has a history of kidney stones. Which statement by the client indicates an increased risk for renal calculi?

• A. Eats a vegetarian diet with cheese 2 to 3 times a day
• B. Experiences additional stress since adopting a child
• C. Jogs more frequently than usual daily routine
• D. Drinks several bottles of carbonated water daily

Correct answer: D

Rationale: The correct answer is D. Drinking several bottles of carbonated water daily may contribute to renal calculi formation due to the high mineral content. Carbonated drinks can increase the risk of kidney stones due to their high levels of phosphoric acid and caffeine, which can lead to the formation of crystals in the urine. Choices A, B, and C are less likely to directly contribute to an increased risk of renal calculi compared to the excessive consumption of carbonated water.

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