Nursing Elites

1. A client scheduled for the surgical creation of an ileal conduit expresses anxiety and asks about having a drainage tube. How should the nurse respond?

• A. I will ask the provider to prescribe you an antianxiety medication.
• B. Would you like to discuss the procedure with your doctor once more?
• C. I think it would be nice to not have to worry about finding a bathroom.
• D. Would you like to speak with someone who has an ileal conduit?

Correct answer: D

Rationale: The most appropriate response for the nurse is to offer the client the opportunity to speak with someone who has undergone the same procedure. This allows the client to gain insight, ask questions, and share concerns with someone who has firsthand experience, which can help alleviate anxiety and promote a positive self-image. Seeking an antianxiety medication does not address the client's emotional concerns or promote a positive attitude towards the procedure. Discussing the procedure with the doctor again may provide more information but may not offer the same level of emotional support and understanding as speaking with someone who has lived through the experience. Commenting on the convenience of not having to search for a bathroom minimizes the client's anxiety and overlooks the emotional aspect of the client's concerns.

2. A client with acute glomerulonephritis (GN) is being evaluated by a nurse. Which manifestation should the nurse recognize as a positive response to the prescribed treatment?

• A. The client has lost 11 pounds in the past 10 days.
• B. The client’s urine specific gravity is 1.048.
• C. No blood is observed in the client’s urine.
• D. The client’s blood pressure is 152/88 mm Hg.

Correct answer: A

Rationale: A weight loss of 11 pounds in the past 10 days indicates fluid loss, a positive response to treatment for acute glomerulonephritis. It signifies that the glomeruli are functioning adequately to filter excess fluid. A urine specific gravity of 1.048 is high, indicating concentrated urine, which is not a positive response in this context. Blood in the urine is not a typical finding in glomerulonephritis, so its absence is expected and does not indicate a positive response to treatment. A blood pressure of 152/88 mm Hg is elevated and may suggest kidney damage or fluid overload, which are not positive responses to treatment.

3. The healthcare provider is assessing the client's use of medications. Which of the following medications may cause a complication with the treatment plan of a client with diabetes?

• A. Aspirin
• B. Steroids
• C. Sulfonylureas
• D. Angiotensin-converting enzyme (ACE) inhibitors

Correct answer: B

Rationale: The correct answer is B: Steroids. Steroids can induce hyperglycemia, complicating diabetes management by raising blood sugar levels. Aspirin is not typically associated with causing complications in diabetic clients. Sulfonylureas are oral antidiabetic medications that can lower blood sugar levels and are commonly used in diabetes management, making them beneficial rather than harmful. Angiotensin-converting enzyme (ACE) inhibitors are medications often prescribed to manage hypertension in diabetic clients and do not typically interfere with diabetes treatment plans.

4. 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.

5. Which of the following is a characteristic of chronic obstructive pulmonary disease (COPD)?

• A. Increased lung compliance.
• B. Decreased lung elasticity.
• C. Increased respiratory rate.
• D. Increased lung expansion.

Correct answer: B

Rationale: The correct answer is B: Decreased lung elasticity. Chronic obstructive pulmonary disease (COPD) is characterized by a loss of lung elasticity, which leads to difficulty in exhaling air. This decreased elasticity results in air becoming trapped in the lungs, making it challenging for the individual to breathe effectively. Choice A is incorrect as COPD is associated with decreased lung compliance, not increased compliance. Choice C is incorrect as individuals with COPD often have a decreased respiratory rate due to impaired lung function. Choice D is incorrect as COPD causes limited lung expansion due to factors like air trapping and hyperinflation.

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