Nursing Elites

1. A client with diabetes mellitus is scheduled to have blood drawn for a fasting blood glucose determination in the morning. What does the nurse tell the client is acceptable to consume on the morning of the test?

• A. Water
• B. Tea without sugar
• C. Coffee without milk
• D. Clear liquids like apple juice

Correct answer: A

Rationale: The correct answer is A: Water. A client scheduled for a fasting blood glucose test should only consume water after midnight to ensure accurate test results. Choosing options B, C, or D, which include tea, coffee, or clear liquids like apple juice, is incorrect as they may contain substances that can affect the blood glucose levels, leading to inaccurate test results.

2. When conducting discharge teaching for a client diagnosed with diverticulosis, which diet instruction should the nurse include?

• A. Eat a high-fiber diet and increase fluid intake.
• B. Have small frequent meals and sit up for at least two hours after meals.
• C. Eat a bland diet and avoid spicy foods.
• D. Eat a soft diet with increased intake of milk and milk products.

Correct answer: A

Rationale: A high-fiber diet with increased fluid intake is the most appropriate diet instruction for a client diagnosed with diverticulosis. High-fiber foods help prevent constipation and promote bowel regularity, reducing the risk of complications such as diverticulitis. Adequate fluid intake is crucial to soften stool and aid in digestion. Choice B, having small frequent meals and sitting up after meals, may be beneficial for some gastrointestinal conditions but is not specific to diverticulosis. Choice C, eating a bland diet and avoiding spicy foods, is not necessary for diverticulosis management. Choice D, consuming a soft diet with increased milk and milk products, may worsen symptoms in diverticulosis due to the potential for increased gas production and bloating.

3. A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.)

• A. Urge incontinence involves a post-void residual volume less than 50 mL.
• B. Stress incontinence occurs due to weak pelvic floor muscles.
• C. Stress incontinence usually occurs in people with dementia.
• D. Urge incontinence can be managed by increasing fluid intake.

Correct answer: B

Rationale: The correct statement to include in the education about urge incontinence and stress incontinence is choice B. Stress incontinence occurs due to weak pelvic floor muscles or urethral sphincter, leading to the inability to tighten the urethra sufficiently to overcome increased detrusor pressure. This condition is common after childbirth when pelvic muscles are stretched and weakened. Urge incontinence, on the other hand, is characterized by the inability to suppress the contraction signal from the detrusor muscle. It is often associated with abnormal detrusor contractions, which can be due to neurological abnormalities rather than post-void residual volume. Choice A is incorrect because urge incontinence is not defined by post-void residual volume. Choice C is incorrect as stress incontinence is not usually linked to dementia. Choice D is incorrect because increasing fluid intake is not a management strategy for urge incontinence.

4. In a patient with chronic kidney disease, which of the following is a common electrolyte imbalance?

• A. Hyperkalemia.
• B. Hypokalemia.
• C. Hypernatremia.
• D. Hyponatremia.

Correct answer: A

Rationale: Hyperkalemia is a common electrolyte imbalance in chronic kidney disease. In chronic kidney disease, the kidneys' reduced function leads to the decreased excretion of potassium, resulting in elevated serum potassium levels. This can be dangerous as hyperkalemia can lead to life-threatening arrhythmias. Hypokalemia (Choice B) is less common in chronic kidney disease as the impaired kidneys tend to retain potassium. Hypernatremia (Choice C) is more commonly seen in conditions such as dehydration, not primarily in chronic kidney disease. Hyponatremia (Choice D) is also possible in chronic kidney disease but is less common compared to hyperkalemia.

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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