Nursing Elites

1. A nurse cares for a client with urinary incontinence. The client states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How should the nurse respond?

• A. I understand how you feel. I would be mortified.
• B. Incontinence pads will minimize leaks in public.
• C. I can teach you strategies to help control your incontinence.
• D. More women experience incontinence than you might think.

Correct answer: C

Rationale: The nurse should accept and acknowledge the client’s concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client’s concerns with the use of pads or stating statistics about the occurrence of incontinence.

2. After teaching a client with nephrotic syndrome and a normal glomerular filtration rate, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition?

• A. I must decrease my intake of fat.
• B. I will increase my intake of protein.
• C. A decreased intake of carbohydrates will be required.
• D. An increased intake of vitamin C is necessary.

Correct answer: B

Rationale: In nephrotic syndrome, there is significant renal loss of protein leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by an increased intake of protein. Therefore, the correct statement indicating a correct understanding of the nutritional therapy for this condition is increasing protein intake. Decreasing fat, decreasing carbohydrates, or increasing vitamin C intake is not necessary for addressing the underlying issues associated with nephrotic syndrome.

3. 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.

4. After a client with peripheral vascular disease undergoes a right femoral-popliteal bypass graft, their blood pressure drops from 124/80 to 94/62. What should the nurse assess first?

• A. IV fluid infusion.
• B. Pedal pulses.
• C. Nasal cannula oxygen flow rate.
• D. Capillary refill time.

Correct answer: B

Rationale: Assessing pedal pulses is crucial in this situation as it helps determine the adequacy of perfusion to the lower extremity following a bypass graft. A decrease in blood pressure postoperatively could indicate decreased perfusion, making the assessment of pedal pulses a priority to ensure proper circulation. Checking IV fluid infusion, nasal cannula oxygen flow rate, or capillary refill time are not the immediate priorities in this scenario and would not provide direct information about perfusion to the affected extremity.

5. 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.

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