Nursing Elites

1. A nurse assesses a client who is recovering from a radical nephrectomy for renal cell carcinoma. The nurse notes that the client’s blood pressure has decreased from 134/90 to 100/56 mm Hg and urine output is 20 mL for this past hour. Which action should the nurse take?

• A. Position the client to lay on the surgical incision.
• B. Measure the specific gravity of the client’s urine.
• C. Administer intravenous pain medications.
• D. Assess the rate and quality of the client’s pulse.

Correct answer: D

Rationale: The nurse should first fully assess the client for signs of volume depletion and shock, and then notify the provider. The radical nature of the surgery and the proximity of the surgery to the adrenal gland put the client at risk for hemorrhage and adrenal insufficiency. Hypotension is a clinical manifestation associated with both hemorrhage and adrenal insufficiency. Hypotension is particularly dangerous for the remaining kidney, which must receive adequate perfusion to function effectively. Re-positioning the client, measuring specific gravity, and administering pain medication would not provide data necessary to make an appropriate clinical decision, nor are they appropriate interventions at this time.

2. What is the most common side effect of diuretics such as furosemide (Lasix)?

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

Correct answer: A

Rationale: The correct answer is 'Hypokalemia.' Diuretics like furosemide increase the excretion of potassium, leading to hypokalemia as a common side effect. Hyperkalemia (choice B) is the opposite condition characterized by high potassium levels, which is not typically associated with furosemide use. Hypernatremia (choice C) is increased sodium levels, while hyponatremia (choice D) is decreased sodium levels, neither of which are the most common side effects of furosemide. Therefore, choice A is the best answer.

3. In assessing cancer risk, which woman is at greatest risk of developing breast cancer?

• A. A 35-year-old multipara who never breastfed.
• B. A 50-year-old whose mother had unilateral breast cancer.
• C. A 55-year-old whose mother-in-law had bilateral breast cancer.
• D. A 20-year-old whose menarche occurred at age 9.

Correct answer: B

Rationale: The correct answer is B because family history of breast cancer, specifically in the mother, is a significant risk factor for developing breast cancer. The age of 50 is also a risk factor for breast cancer. Choice A is less likely as breastfeeding can actually reduce the risk of breast cancer. Choice C is less relevant since the risk is higher with a direct family member. Choice D, although early menarche is a risk factor, the age of the individual is much lower compared to the other age-related risk factors.

4. A client presents with a fungal urinary tract infection (UTI). Which assessments should the nurse complete? (Select all that apply.)

• A. Palpate the kidneys and bladder.
• B. Assess the medical history and current medical problems.
• C. Perform a bladder scan to assess post-void residual.
• D. Inquire about recent travel to foreign countries.

Correct answer: B

Rationale: When assessing a client with a fungal UTI, the nurse should prioritize gathering information related to the medical history and current medical problems. Clients who are severely immunocompromised or have conditions like diabetes mellitus are more susceptible to fungal UTIs. Assessing the medical history helps identify risk factors and potential causes of the infection. While physical examinations like palpating the kidneys and bladder and performing a bladder scan may be necessary, they should follow the initial assessment of medical history. Inquiring about recent travel to foreign countries is less relevant in the context of a fungal UTI, as the focus should be on immediate medical factors predisposing the client to the infection.

5. What is the primary action of insulin in the body?

• A. To lower blood pressure.
• B. To promote the absorption of glucose into cells.
• C. To increase blood glucose levels.
• D. To decrease blood glucose levels.

Correct answer: B

Rationale: The correct answer is B: To promote the absorption of glucose into cells. Insulin facilitates the uptake of glucose by cells, thereby decreasing blood glucose levels. Choice A is incorrect as insulin does not directly affect blood pressure. Choice C is inaccurate as insulin works to lower, not increase, blood glucose levels. Choice D is incorrect because insulin's primary role is to lower, not increase, blood glucose levels by promoting glucose uptake into cells.

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