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. A client has an elevated blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?

• A. Assess the client’s dietary habits.
• B. Inquire about the client's use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• C. Hold the client’s metformin (Glucophage).
• D. Contact the health care provider immediately.

Correct answer: A

Rationale: An elevated blood urea nitrogen (BUN)/creatinine ratio can indicate various conditions such as dehydration, urinary obstruction, catabolism, or a high-protein diet. The initial action the nurse should take is to assess the client’s dietary habits to determine if the elevated ratio is related to diet. Inquiring about the use of NSAIDs is important as they can impact kidney function, but dietary causes should be ruled out first. Holding metformin or contacting the health care provider without assessing the dietary habits would be premature actions as they may not address the underlying cause of the elevated BUN/creatinine ratio.

3. A young adult client, admitted to the Emergency Department following a motor vehicle collision, is transfused with 4 units of PRBCs (packed red blood cells). The client's pretransfusion hematocrit is 17%. Which hematocrit value should the nurse expect the client to have after all the PRBCs have been transfused?

• A. 0.19
• B. 0.09
• C. 0.39
• D. 0.29

Correct answer: D

Rationale: The expected increase in hematocrit after transfusion is approximately 3% per unit of PRBCs. Since the client received 4 units, the expected increase would be 4 x 3% = 12%. Therefore, adding this to the pretransfusion hematocrit of 17% would result in an expected post-transfusion hematocrit of 29%. Choice A (0.19) is incorrect as it doesn't consider the incremental increase per unit of PRBCs. Choices B (0.09) and C (0.39) are also incorrect as they do not align with the expected increase in hematocrit following the transfusion of 4 units of PRBCs.

4. 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.

5. A client presents with a urine specific gravity of 1.018. What action should the nurse take?

• A. Evaluate the client’s intake and output for the past 24 hours.
• B. Document the finding in the chart and continue to monitor.
• C. Obtain a specimen for a urine culture and sensitivity.
• D. Encourage the client to drink more fluids, especially water.

Correct answer: B

Rationale: A urine specific gravity of 1.018 falls within the normal range, indicating adequate hydration. Therefore, the appropriate action is to document this finding in the client's chart and continue monitoring. There is no need to evaluate intake and output, as the specific gravity is normal. Obtaining a urine culture and sensitivity or encouraging increased fluid intake is unnecessary in this situation.

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