Nursing Elites

1. What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?

• A. Ask the patient if she might be pregnant.
• B. Reassure the patient that this is a normal side effect.
• C. Report a possible superinfection to the provider.
• D. Suspect that the patient is having a hematologic reaction.

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.

2. Which food is most important to encourage a client with osteomalacia to include in a daily diet?

• A. Fortified milk and cereals
• B. Citrus fruits and juices
• C. Green leafy vegetables
• D. Red meats and eggs

Correct answer: A

Rationale: The correct answer is A: Fortified milk and cereals. Osteomalacia is a condition caused by a deficiency in vitamin D. Fortified milk and cereals are rich sources of vitamin D, which is essential for managing osteomalacia. Citrus fruits and juices (choice B) are high in vitamin C, but vitamin D is the primary concern for osteomalacia. Green leafy vegetables (choice C) are good sources of various nutrients but not the main focus for managing osteomalacia. Red meats and eggs (choice D) are good sources of protein and other nutrients but are not as critical as fortified milk and cereals for addressing vitamin D deficiency in osteomalacia.

3. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?

• A. Decreased urine output
• B. Improved blood oxygenation
• C. Increased interstitial fluid
• D. Stabilization of heart rate and blood pressure

Correct answer: D

Rationale: 6% Dextran 75 is a high molecular-weight colloidal solution used to treat shock from burns or trauma. Colloids like 6% dextran 75 are plasma expanders that help increase blood volume, leading to improved heart rate and blood pressure stabilization. The infusion of plasma expanders does not typically decrease urine output. It primarily aims to stabilize circulation rather than affect blood oxygenation or increase interstitial fluid levels.

4. A client with peripheral arterial disease (PAD) has cool and pale feet with diminished pulses. Which of the following interventions should the nurse implement?

• A. Keep the legs elevated above the level of the heart.
• B. Encourage the client to exercise daily.
• C. Apply warm compresses to the affected area.
• D. Apply ice packs to the affected area.

Correct answer: C

Rationale: In peripheral arterial disease (PAD), there is decreased blood flow to the extremities. Applying warm compresses helps dilate blood vessels, improve circulation, and relieve symptoms. Elevating the legs above the heart level may further compromise blood flow. Encouraging daily exercise is important in PAD management but may not be appropriate when the client has cool, pale feet with diminished pulses. Applying ice packs can worsen vasoconstriction and further reduce blood flow, exacerbating symptoms in PAD.

5. A client has pyelonephritis and expresses embarrassment about discussing symptoms. How should the nurse respond?

• A. Assure the client that their symptoms will be kept confidential.
• B. Acknowledge the client's discomfort and avoid discussing elimination topics.
• C. Encourage the use of familiar language and assure the client they can take their time.
• D. Offer the client a nurse of the same gender to provide care.

Correct answer: C

Rationale: When a client expresses embarrassment or discomfort in discussing symptoms related to sensitive topics like elimination and the genitourinary area, the nurse should respond by encouraging the client to use words they are comfortable with. This helps the client feel more at ease and opens up communication. Offering a nurse of the same gender may not address the client's discomfort with discussing symptoms. Assuring confidentiality is important, but it should not be promised in a way that may not be fulfilled. Avoiding the topic of elimination entirely does not address the client's feelings or promote effective communication.

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