Nursing Elites

1. A client with renal calculi is being assessed by a nurse. Which question should the nurse ask?

• A. Is there a family history of this problem?
• B. Do you consume cranberry juice?
• C. Do you urinate after sexual intercourse?
• D. Do you have burning sensation during urination?

Correct answer: A

Rationale: When assessing a client with renal calculi, it is important for the nurse to inquire about a family history of the problem. There is a genetic predisposition associated with renal stone formation, making it essential to assess if other family members have experienced renal stones. Choices B, C, and D are not directly related to renal calculi. Consuming cranberry juice is more relevant to urinary tract health, urinating after sexual intercourse is related to preventing urinary tract infections, and experiencing a burning sensation during urination is a symptom commonly associated with urinary tract infections, not renal calculi.

2. How can a nurse best help a client undergoing a bone marrow aspiration and biopsy, along with two upset family members, manage anxiety during the procedure?

• A. Allow the client's family to stay for emotional support.
• B. Accompany the client silently.
• C. Encourage the client to take slow, deep breaths to promote relaxation.
• D. Provide the client an opportunity to verbalize emotions.

Correct answer: C

Rationale: Encouraging the client to take slow, deep breaths is an effective way for the nurse to help the client manage anxiety during the bone marrow aspiration and biopsy procedure. Slow, deep breathing can promote relaxation and help reduce anxiety levels. Choice A, allowing the client's family to stay for emotional support, may provide comfort but does not address a direct intervention to help manage anxiety. Choice B, staying with the client silently, may not actively help the client address their anxiety. Choice D, allowing the client to express feelings, is important but may not directly address anxiety management during the procedure.

3. A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 62, PaCO2 59, and HCO3. Which statement describes the most likely cause of the simultaneous increase in both the PaO2 and the PaCO2?

• A. The hypercapnia resulted from the rapid respirations.
• B. The hypoxic drive was reduced by the oxygen therapy.
• C. The client had a pneumothorax which restricted ventilation.
• D. The client had a pulmonary embolism that reduced perfusion.

Correct answer: B

Rationale: In patients with COPD, oxygen therapy can reduce the hypoxic drive, which is the primary stimulus for breathing in these individuals. By providing supplemental oxygen, the hypoxic drive is diminished, resulting in decreased respiratory effort. As a consequence, the PaO2 may increase due to the supplemental oxygen, but this can lead to a decrease in the respiratory drive and subsequent retention of carbon dioxide, causing an increase in PaCO2 levels. Option A is incorrect because rapid respirations would typically lower PaCO2 levels. Option C is incorrect as a pneumothorax would lead to impaired gas exchange and decreased PaO2 levels without necessarily affecting PaCO2 levels. Option D is incorrect as a pulmonary embolism would typically result in ventilation-perfusion mismatch and decreased PaO2 levels without directly impacting PaCO2 levels.

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 client with type 1 diabetes mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 PM each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

• A. 11 AM, shortly before lunch.
• B. 1 PM, shortly after lunch.
• C. 6 PM, shortly after dinner.
• D. 1 AM, while sleeping.

Correct answer: D

Rationale: The correct answer is D, 1 AM, while sleeping. Isophane insulin suspension NPH (Humulin N) peaks around 6-8 hours after administration, which increases the risk of hypoglycemia during the night. Choice A, 11 AM, shortly before lunch, is incorrect because the peak effect of NPH insulin occurs much later. Choice B, 1 PM, shortly after lunch, is incorrect as it is too early for the peak effect of NPH insulin. Choice C, 6 PM, shortly after dinner, is also incorrect because the peak risk of hypoglycemia with NPH insulin occurs later in the night.

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