Nursing Elites

1. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?

• A. Your immune system becomes less effective as you age.
• B. Low estrogen levels can make the tissue more susceptible to infection.
• C. You should be more careful with your personal hygiene in this area.
• D. It is likely that you have an untreated sexually transmitted disease.

Correct answer: B

Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.

2. After educating a client with hypertension secondary to renal disease, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional teaching?

• A. I can prevent more damage to my kidneys by managing my blood pressure.
• B. If I have increased urination at night, I need to drink less fluid during the day.
• C. I need to see the registered dietitian to discuss limiting my protein intake.
• D. It is important that I take my antihypertensive medications as directed.

Correct answer: B

Rationale: Choice B is incorrect because the client should not restrict fluids during the day due to increased urination at night. Clients with renal disease may be prescribed fluid restrictions, and they should be thoroughly assessed for potential dehydration. To decrease increased nocturnal voiding, clients should consume fluids earlier in the day. Choices A, C, and D are correct statements. Managing blood pressure is crucial to slow the progression of renal dysfunction. Limiting protein intake is important in renal disease management, and clients should be referred to a dietitian as needed. Taking antihypertensive medications as directed is essential for blood pressure control.

3. The patient weighs 75 kg and is receiving IV fluids at a rate of 50 mL/hour, having consumed 100 mL orally in the past 24 hours. What action will the nurse take?

• A. Contact the provider to ask about increasing the IV rate to 90 mL/hour.
• B. Discuss with the provider the need to increase the IV rate to 150 mL/hour.
• C. Encourage the patient to drink more water so the IV can be discontinued.
• D. Instruct the patient to drink 250 mL of water every 8 hours.

Correct answer: A

Rationale: The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. For a patient weighing 75 kg, the minimum intake should be 2250 mL/day. The patient is currently receiving 1200 mL IV and 100 mL orally, totaling 1300 mL. Increasing the IV rate to 90 mL/hour would provide a total of 2160 mL, which could meet the patient's needs if oral intake continues. Option B suggests increasing the IV rate to 150 mL/hour, resulting in an excessive fluid intake of 3600 mL/day, surpassing the recommended amount. Option C, encouraging increased fluid intake, is not recommended as the patient is already struggling with fluid intake. Option D, instructing the patient to drink 250 mL of water every 8 hours, would still fall short of the required fluid intake of 2250 mL/day.

4. The home health nurse provides teaching about insulin self-injection to a client who was recently diagnosed with diabetes mellitus. When the client begins to perform a return demonstration of an insulin injection into the abdomen, which instruction should the nurse provide?

• A. Select a different injection site
• B. Continue with the insulin injection
• C. Keep the skin flat rather than bunched
• D. Lie down flat for better skin exposure

Correct answer: B

Rationale: Choosing to continue with the insulin injection is the correct instruction in this scenario because it allows the client to demonstrate proper technique and reinforces their learning. Selecting a different injection site (choice A) is not necessary if the client is injecting into the abdomen as it is a suitable site. Keeping the skin flat rather than bunched (choice C) is a good practice but is not the priority in this situation where the client is demonstrating the injection technique. Lying down flat for better skin exposure (choice D) is not required and may not be practical for the client during routine self-injections.

5. A client in a physician’s office has just made an appointment for an exercise stress test. The client should be instructed to:

• A. Wear sweatpants and a heavy sweatshirt
• B. Eat a small meal just before the procedure
• C. Wear comfortable rubber-soled shoes such as sneakers
• D. Avoid consuming caffeine for 30 minutes before the procedure

Correct answer: C

Rationale: The client should wear comfortable rubber-soled shoes, such as sneakers, for the exercise stress test. This choice ensures safety and stability during the procedure. Wearing sweatpants and a heavy sweatshirt (Choice A) would not be appropriate as the client needs to wear light, loose, comfortable clothing. Eating a small meal just before the procedure (Choice B) could lead to discomfort during the test. Avoiding caffeine for 30 minutes before the procedure (Choice D) is not a specific instruction related to the attire or preparation for the test.

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