Nursing Elites

1. A client with chronic renal failure is prescribed a low-protein diet. The nurse should explain to the client that the purpose of this diet is to:

• A. Prevent fluid overload.
• B. Reduce the workload on the kidneys.
• C. Prevent dehydration.
• D. Maintain electrolyte balance.

Correct answer: B

Rationale: The correct answer is B: 'Reduce the workload on the kidneys.' A low-protein diet is prescribed for clients with chronic renal failure to decrease the production of urea and other nitrogenous wastes, which can accumulate in the body when the kidneys are not functioning properly. This reduction in protein intake helps to lessen the burden on the kidneys, as they may have difficulty in filtering and excreting waste products. Choice A is incorrect because fluid overload is more related to restrictions in fluid intake rather than protein intake. Choice C is incorrect as a low-protein diet does not directly prevent dehydration. Choice D is incorrect because while electrolyte balance is essential in renal failure, the primary purpose of a low-protein diet is to reduce the workload on the kidneys by limiting the production of waste products.

2. After teaching a client with nephrotic syndrome and a normal glomerular filtration rate, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition?

• A. I must decrease my intake of fat.
• B. I will increase my intake of protein.
• C. A decreased intake of carbohydrates will be required.
• D. An increased intake of vitamin C is necessary.

Correct answer: B

Rationale: In nephrotic syndrome, there is significant renal loss of protein leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by an increased intake of protein. Therefore, the correct statement indicating a correct understanding of the nutritional therapy for this condition is increasing protein intake. Decreasing fat, decreasing carbohydrates, or increasing vitamin C intake is not necessary for addressing the underlying issues associated with nephrotic syndrome.

3. An unlicensed assistive personnel (UAP) reports to the nurse that a client with a postoperative wound infection has a temperature of 103°F (39.4°C), blood pressure of 90/70, pulse of 124 beats/minute, and respirations of 28 breaths/minute. When assessing the client, findings include mottled skin appearance and confusion. Which action should the nurse take first?

• A. Transfer the client to the ICU.
• B. Initiate an infusion of intravenous (IV) fluids.
• C. Assess the client's core temperature.
• D. Obtain a wound specimen for culture.

Correct answer: B

Rationale: Initiating an infusion of IV fluids is the priority action to stabilize blood pressure in a client with signs of sepsis. Intravenous fluids help maintain perfusion to vital organs and prevent further deterioration. Option A is not the immediate priority as stabilizing the client's condition can be initiated in the current setting. Option C, assessing the client's core temperature, is important but not the most critical action at this time. Option D, obtaining a wound specimen for culture, is important for identifying the causative organism but is not the first priority in managing a client with signs of sepsis.

4. Which of the following is the most appropriate diet for a client during the acute phase of myocardial infarction?

• A. Liquids as desired.
• B. Small, easily digested meals.
• C. Three regular meals per day.
• D. Nothing by mouth.

Correct answer: B

Rationale: During the acute phase of myocardial infarction, it is recommended to provide small, easily digested meals for the client. This type of diet is better tolerated as it reduces the workload on the heart, allowing for easier digestion and absorption of nutrients. Choice A, 'Liquids as desired,' may not provide adequate nutrition and may not be well-balanced. Choice C, 'Three regular meals per day,' may be too heavy for the client's weakened condition. Choice D, 'Nothing by mouth,' is not appropriate as the client still requires essential nutrients for recovery.

5. The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss

• A. decreasing the dose to 50 mg QID.
• B. giving the dose 3 times daily.
• C. obtaining a serum drug level.
• D. ordering a hearing test.

Correct answer: C

Rationale: When a patient receiving gentamicin (Garamycin) reports experiencing ringing in the ears, it is crucial to consider the possibility of ototoxicity. Ototoxicity is a known adverse effect of aminoglycosides. The appropriate action for the nurse in this situation is to contact the provider to discuss obtaining a serum drug level. This is important to assess the drug concentration in the patient's blood, which can help determine if the ringing in the ears is related to the medication. Decreasing the dose or changing the dosing frequency without assessing the serum drug level may not address the underlying issue and could potentially lead to suboptimal treatment. Ordering a hearing test may be necessary at a later stage if the serum drug level indicates a concern. Therefore, option C, obtaining a serum drug level, is the most appropriate action to take in this scenario.

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