Nursing Elites

1. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program?

• A. A 78-year-old female who is confused
• B. A 65-year-old male with diabetes mellitus
• C. A 52-year-old female with kidney failure
• D. A 47-year-old male with arthritis

Correct answer: A

Rationale: For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from other types of bladder training. A confused client may need structured assistance to establish a regular bathroom routine, which can help manage urge incontinence effectively. Clients with diabetes mellitus, kidney failure, or arthritis may require different strategies tailored to their specific conditions.

2. What is a priority goal for the diabetic client who is taking insulin and experiencing nausea and vomiting from a viral illness or influenza?

• A. Ensuring adequate food intake.
• B. Managing personal health.
• C. Relieving pain.
• D. Increasing physical activity.

Correct answer: A

Rationale: Ensuring adequate food intake is a priority goal for a diabetic client taking insulin and experiencing nausea and vomiting due to a viral illness or influenza because maintaining proper nutrition is essential to prevent complications such as ketoacidosis. During illness, it is crucial for diabetic individuals to continue to consume appropriate amounts of food to maintain stable blood sugar levels and prevent hypoglycemia. Managing personal health (choice B) is important but not the priority in this situation. Relieving pain (choice C) may be necessary if present but is not the priority over ensuring food intake. Increasing physical activity (choice D) is not recommended during illness, especially when the individual is experiencing nausea and vomiting.

3. A client with an oversecretion of renin has a health history reviewed by a nurse. Which disorder should the nurse correlate with this assessment finding?

• A. Alzheimer’s disease
• B. Hypertension
• C. Diabetes mellitus
• D. Viral hepatitis

Correct answer: B

Rationale: Renin is secreted in response to low blood volume, blood pressure, or blood sodium levels. Excessive renin secretion can lead to persistent hypertension. Renin plays no role in Alzheimer's disease, diabetes mellitus, or viral hepatitis. Therefore, the correct correlation with oversecretion of renin is hypertension.

4. The nurse is assessing a client with chronic kidney disease (CKD). Which finding is most important for the nurse to respond to first?

• A. Potassium 6.0 mEq/L.
• B. Daily urine output of 400 ml.
• C. Peripheral neuropathy.
• D. Uremic fetor.

Correct answer: A

Rationale: The correct answer is A. Potassium level of 6.0 mEq/L indicates hyperkalemia, which is a critical electrolyte imbalance in clients with chronic kidney disease. Hyperkalemia can lead to life-threatening arrhythmias, making it the priority finding to address. Choice B, a daily urine output of 400 ml, may indicate decreased kidney function but does not pose an immediate life-threatening risk compared to hyperkalemia. Peripheral neuropathy (Choice C) and uremic fetor (Choice D) are common manifestations of CKD but are not as urgent as addressing a potentially fatal electrolyte imbalance like hyperkalemia.

5. Polyethylene glycol–electrolyte solution (GoLYTELY) is prescribed for a hospitalized client scheduled for a colonoscopy. The client begins to experience diarrhea after drinking the solution. Which action by the nurse is appropriate?

• A. Calling the physician
• B. Administering a cleansing enema
• C. Documenting the diarrhea in the medical record
• D. Giving intravenous replacement fluids in large amounts

Correct answer: C

Rationale: The correct action by the nurse in this situation is to document the diarrhea in the medical record. Polyethylene glycol–electrolyte solution (GoLYTELY) is a bowel evacuant used to cleanse the bowel before a colonoscopy. It is expected to cause mild diarrhea, which is a normal response to the medication. The diarrhea helps clear the bowel in preparation for the procedure. Calling the physician is not necessary unless there are complications. Administering a cleansing enema or giving intravenous replacement fluids in large amounts are not appropriate actions as they are not indicated for managing the expected diarrhea caused by GoLYTELY.

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