Nursing Elites

1. A client admitted from a nursing home after several recent falls needs a urine sample for culture and sensitivity. What should the nurse complete first?

• A. Obtain urine sample for culture and sensitivity.
• B. Administer intravenous antibiotics.
• C. Encourage protein intake and additional fluids.
• D. Consult physical therapy for gait training.

Correct answer: A

Rationale: In this scenario, the priority intervention is to obtain a urine sample for culture and sensitivity. Older adults with recent falls may have atypical symptoms of urinary tract infection (UTI), which can present as new-onset confusion or falling. It is crucial to rule out UTI before initiating antibiotics. While administering antibiotics, encouraging protein intake, fluids, and consulting physical therapy are important interventions, they should follow the urine sample collection to ensure accurate diagnosis and appropriate treatment.

2. A client is receiving continuous ambulatory peritoneal dialysis. Which of the following statements indicates the need for more teaching by the nurse?

• A. I should take all my medications every morning.
• B. The catheter should always remain in place.
• C. The catheter should be flushed daily with sterile saline.
• D. If I gain 2 pounds, I should skip dialysis that day.

Correct answer: D

Rationale: The correct answer is D. Gaining weight is a sign that the client may be retaining fluid, indicating a need for dialysis to remove excess fluid. Skipping dialysis based on weight gain can lead to fluid overload, electrolyte imbalances, and other serious complications. Choices A, B, and C are all correct statements regarding peritoneal dialysis care: taking medications as prescribed is essential for overall health, ensuring the catheter remains in place is crucial to prevent infection, and flushing the catheter with sterile saline daily helps maintain its patency and reduce the risk of infections.

3. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

4. A client with a family history of polycystic kidney disease (PKD is being assessed by a nurse. For which clinical manifestations should the nurse assess? (Select all that apply.)

• A. Nocturia
• B. Flank pain
• C. Increased abdominal girth
• D. B & C

Correct answer: D

Rationale: Clients with PKD commonly present with flank pain and increased abdominal girth due to abdominal distention caused by cysts. Bloody urine is also a common symptom due to tissue damage from PKD. Nocturia and dysuria are not typical manifestations of PKD. Constipation is not directly associated with PKD. Therefore, the correct choices are flank pain and increased abdominal girth, making option D the correct answer.

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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