Nursing Elites

1. A client with autosomal dominant polycystic kidney disease (ADPKD) asks, “Will my children develop this disease?” How should the nurse respond?

• A. No genetic link is known, so your children are not at increased risk.
• B. Your sons will develop this disease because it has a sex-linked gene.
• C. Only if both you and your spouse are carriers of this disease.
• D. Each of your children has a 50% risk of having ADPKD.

Correct answer: D

Rationale: Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that causes the disease. ADPKD is transmitted as an autosomal dominant trait and therefore is not gender-specific. Both parents do not need to have this disorder. Choice A is incorrect because ADPKD has a known genetic link and a definitive mode of inheritance. Choice B is incorrect as ADPKD is not sex-linked but autosomal dominant. Choice C is incorrect because ADPKD follows an autosomal dominant inheritance pattern and does not require both parents to be carriers for the child to inherit the disease.

2. An adult client is admitted with flank pain and is diagnosed with acute pyelonephritis. What is the priority nursing action?

• A. Monitor hemoglobin and hematocrit
• B. Encourage turning and deep breathing
• C. Administer IV antibiotics as prescribed
• D. Auscultate for presence of bowel sounds

Correct answer: C

Rationale: The priority nursing action for a client diagnosed with acute pyelonephritis is to administer IV antibiotics as prescribed. Acute pyelonephritis is a serious kidney infection that requires prompt antibiotic therapy to prevent systemic complications and worsening of the infection. While monitoring hemoglobin and hematocrit (Choice A) is important, it is not the priority in the acute phase of infection. Encouraging turning and deep breathing (Choice B) and auscultating for bowel sounds (Choice D) are relevant aspects of care but do not take precedence over initiating antibiotic treatment to address the infection promptly.

3. The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is:

• A. Decreased blood flow.
• B. Increased blood flow.
• C. Slow blood flow.
• D. Thrombus formation.

Correct answer: A

Rationale: The correct answer is A: 'Decreased blood flow.' In peripheral vascular disease (PVD), there is a narrowing or blockage of blood vessels, leading to reduced blood flow to the extremities. This decreased blood flow results in inadequate oxygen supply to the muscles, causing pain, especially during physical activity when oxygen demand increases. Choice B, 'Increased blood flow,' is incorrect because PVD is characterized by impaired blood circulation rather than increased flow. Choice C, 'Slow blood flow,' is not precise as PVD involves a more significant reduction in blood flow. Choice D, 'Thrombus formation,' is related to the formation of blood clots within vessels, which can be a complication of PVD but is not its main characteristic.

4. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?

• A. Administer the amoxicillin and have epinephrine available.
• B. Ask the provider to order an antihistamine.
• C. Contact the provider to discuss using a different antibiotic.
• D. Request an order for a beta-lactamase-resistant drug.

Correct answer: C

Rationale: When a patient has a history of rash from penicillin, it indicates a potential allergic reaction to penicillin and other related drugs, such as amoxicillin. It is crucial to avoid administering penicillins to such patients unless there is no alternative. The nurse's best action in this situation is to contact the provider to discuss using a different antibiotic from a different class. This approach helps prevent potential severe allergic reactions. While epinephrine and antihistamines are used to manage allergic reactions, administering amoxicillin despite the known allergy is not advisable and could lead to serious consequences. Requesting a beta-lactamase-resistant drug does not address the issue of potential allergic reactions in this scenario.

5. A client with chronic heart failure is being taught by a nurse about the importance of daily weights. Which of the following instructions should the nurse include?

• A. Weigh yourself at the same time every day.
• B. Use the same scale for weighing each time.
• C. Record your weight in a journal or log.
• D. Report any weight gain of more than 2 to 3 pounds in a day.

Correct answer: D

Rationale: The correct instruction for a client with chronic heart failure is to report any weight gain of more than 2 to 3 pounds in a day. This weight gain may indicate fluid retention, which is a critical sign of worsening heart failure. Weighing at the same time every day and using the same scale for consistency are good practices, but the crucial action is to promptly report significant weight gain, as stated in option D. Recording the weight in a journal or log can be helpful for tracking trends, but immediate reporting of weight gain is essential for timely intervention in heart failure management. Therefore, option D is the most appropriate instruction for this client.

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