Nursing Elites

1. A client who is 2 hours postoperative following a kidney biopsy is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Urinary output of 30 mL/hr.
• B. Hemoglobin 10 g/dL.
• C. Respiratory rate of 16/min.
• D. Blood pressure 110/70 mm Hg.

Correct answer: B

Rationale: The correct answer is B. A hemoglobin level of 10 g/dL is below the normal range and should be reported following a kidney biopsy to check for bleeding. Decreased hemoglobin levels could indicate internal bleeding, which is a significant concern postoperatively. Choices A, C, and D are within normal limits and do not require immediate reporting. Urinary output of 30 mL/hr is also within the acceptable range for a postoperative client. A respiratory rate of 16/min and blood pressure of 110/70 mm Hg are both normal findings postoperatively.

2. A client who is at 10 weeks of gestation is being taught about nutrition during pregnancy. Which statement by the client indicates an understanding of the teaching?

• A. I should consume 1,200 calories per day.
• B. I should increase my daily intake of folic acid.
• C. I should drink 2 liters of water each day.
• D. I should limit my intake of iron-rich foods.

Correct answer: B

Rationale: The correct answer is B. Increasing folic acid intake is crucial during pregnancy to prevent neural tube defects. Option A is incorrect because calorie requirements during pregnancy vary and are generally higher than 1,200 calories per day. Option C is not specific to pregnancy nutrition teaching, although hydration is important. Option D is incorrect as iron-rich foods are typically recommended during pregnancy to prevent anemia.

3. What is the initial action for a healthcare provider when a patient presents with shortness of breath?

• A. Administer oxygen
• B. Reposition the patient
• C. Check for abnormal breath sounds
• D. Check oxygen saturation

Correct answer: A

Rationale: Administering oxygen is the initial action for a healthcare provider when a patient presents with shortness of breath because it helps alleviate the patient's symptoms by improving oxygenation. Providing oxygen takes precedence over other actions such as repositioning the patient, checking for abnormal breath sounds, or assessing oxygen saturation. While these actions are important, ensuring the patient has an adequate oxygen supply is crucial in the initial management of shortness of breath.

4. A client with type 1 diabetes mellitus is receiving foot care education from a nurse. Which of the following instructions should the nurse include?

• A. Soak your feet in warm water daily.
• B. Wear cotton socks.
• C. Apply lotion to your feet after bathing.
• D. Trim toenails straight across.

Correct answer: D

Rationale: The correct answer is D: 'Trim toenails straight across.' In clients with diabetes, trimming toenails straight across is important to prevent ingrown toenails, reducing the risk of infections. Soaking feet in warm water daily (choice A) can lead to dry skin and potentially cause skin breakdown in diabetic clients. While wearing cotton socks (choice B) is beneficial for good foot hygiene, it is not as crucial as trimming toenails correctly. Applying lotion to feet after bathing (choice C) is helpful for moisturizing the skin, but the emphasis should be on nail care to prevent complications like ingrown toenails.

5. A client is being taught about patient-controlled analgesia (PCA). Which statement should be included in the teaching?

• A. The PCA will deliver a double dose of medication when you push the button twice.
• B. Continuous PCA infusion is designed to allow fluctuating plasma medication levels.
• C. You should push the button before physical activity to allow maximum pain control.
• D. You can adjust the amount of pain medication you receive by pushing on the keypad.

Correct answer: D

Rationale: The correct statement to include in the teaching about PCA is that the client can adjust the amount of pain medication they receive by pushing on the keypad. This empowers the client to control their pain management effectively. Choice A is incorrect because PCA systems are programmed to prevent double dosing when the button is pressed multiple times in quick succession. Choice B is incorrect as continuous PCA infusion aims to maintain a steady plasma medication level. Choice C is incorrect because it is not necessary to push the button before physical activity to ensure maximum pain control; the client should use the PCA as needed for pain relief.

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