Nursing Elites

1. A client has undergone a bronchoscopy, and a nurse is providing care post-procedure. What should the nurse do first?

• A. Monitor the client's oxygen levels
• B. Encourage the client to eat
• C. Check for a gag reflex
• D. Administer IV fluids

Correct answer: C

Rationale: After a bronchoscopy, the nurse's priority is to check for a gag reflex. This action helps assess the client's ability to protect their airway after sedation. Maintaining airway patency is crucial post-procedure. Monitoring oxygen levels is important but ensuring airway protection takes precedence. Encouraging the client to eat and administering IV fluids are essential aspects of care but are not the immediate priority in this situation.

2. What are the primary causes of respiratory acidosis?

• A. Hypoventilation and lung disease
• B. Hyperventilation and pneumonia
• C. Increased oxygen saturation and tachypnea
• D. Dehydration and hypoxia

Correct answer: A

Rationale: The correct answer is A: Hypoventilation and lung disease. Respiratory acidosis occurs when there is an accumulation of CO2 in the body due to inadequate ventilation. Hypoventilation, which reduces the elimination of CO2, and lung diseases that impair gas exchange are the primary causes. Choice B is incorrect because hyperventilation, not hypoventilation, leads to respiratory alkalosis, not acidosis. Choice C is incorrect because increased oxygen saturation and tachypnea do not directly cause respiratory acidosis. Choice D is incorrect as dehydration and hypoxia do not typically lead to respiratory acidosis.

3. Which dietary instruction is appropriate for a client with chronic kidney disease?

• A. Increase the intake of potassium
• B. Limit the intake of phosphorus-rich foods
• C. Encourage the intake of protein-rich foods
• D. Advise the client to increase fluid intake

Correct answer: B

Rationale: Limiting the intake of phosphorus-rich foods is appropriate for a client with chronic kidney disease. In individuals with chronic kidney disease, the kidneys cannot filter phosphorus effectively, leading to a buildup in the blood. This can result in bone and heart problems. Therefore, reducing phosphorus intake is crucial to prevent complications. Choices A, C, and D are incorrect. Increasing potassium intake may be harmful as potassium levels can accumulate in the blood with impaired kidney function. Encouraging protein-rich foods may not be suitable as excessive protein intake can strain the kidneys. Advising to increase fluid intake should be done cautiously as individuals with chronic kidney disease may need to restrict fluids based on their stage of the disease.

4. A client who is postoperative following a cholecystectomy has a urine output of 25 mL/hr. Which of the following findings should the nurse report to the provider?

• A. Abdominal pain radiating to the right shoulder.
• B. Absent bowel sounds.
• C. Brown drainage on the surgical dressing.
• D. Urine output of 25 mL/hr.

Correct answer: D

Rationale: A urine output below 30 mL/hr indicates a potential complication, such as hypovolemia or renal impairment, and should be reported. Abdominal pain radiating to the right shoulder can be common after a cholecystectomy due to referred pain from the diaphragm, whereas absent bowel sounds may be expected temporarily postoperatively. Brown drainage on the surgical dressing is typical in the early postoperative period and may represent old blood or other normal discharge.

5. A healthcare professional is reviewing the medical record of a client who underwent surgery for a hip fracture. Which of the following findings should the healthcare professional report to the provider?

• A. Clear lung sounds
• B. Fever
• C. Pain in the operative leg
• D. Capillary refill of 2 seconds

Correct answer: B

Rationale: The correct answer is B: Fever. Fever in a postoperative client can indicate an infection, which is a serious complication and should be reported immediately to the provider for further evaluation and management. Clear lung sounds (Choice A) are a positive finding indicating normal respiratory function. Pain in the operative leg (Choice C) is expected postoperatively and should be managed with appropriate pain relief measures. Capillary refill of 2 seconds (Choice D) is within the normal range (less than 3 seconds) and is not a concerning finding postoperatively.

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