Nursing Elites

1. A client recently diagnosed with chronic kidney disease (CKD) is receiving discharge instructions from a nurse. Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

• A. I need to ask for an antibiotic when scheduling a dental appointment.
• B. I’ll need to check my blood sugar often to prevent hypoglycemia.
• C. The dose of my pain medication may have to be adjusted.
• D. The need to watch for bleeding with anticoagulants.

Correct answer: A

Rationale: The correct statements indicating a proper understanding of the teaching include the need for antibiotics for dental work, the potential need to adjust pain medication doses, and the importance of monitoring blood sugar levels. The statement about watching for bleeding with anticoagulants is not directly related to CKD and discharge instructions for this condition. Therefore, option A is correct, as it addresses relevant concerns for a client with CKD, while the other options are either unrelated or not specifically mentioned in the scenario.

2. The healthcare provider is assessing an older Caucasian male who has a history of peripheral vascular disease. The healthcare provider observes that the man's left great toe is black. The discoloration is probably a result of:

• A. Atrophy.
• B. Contraction.
• C. Gangrene.
• D. Rubor.

Correct answer: C

Rationale: Gangrene refers to dead, blackened tissue, often a result of chronic ischemia in clients with peripheral vascular disease. Atrophy (Choice A) is the wasting away or decrease in size of tissue or organ. Contraction (Choice B) refers to the shortening or tightening of a muscle or other body part. Rubor (Choice D) is a red discoloration of the skin, often associated with inflammation or poor circulation, but not typically presenting as blackening like gangrene.

3. Four days following an abdominal aortic aneurysm repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?

• A. Elevate extremities on pillows
• B. Evaluate edema for pitting
• C. Assess pulses with a vascular Doppler
• D. Wrap the feet with warmed blankets

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to assess pulses with a vascular Doppler. The absence of palpable pedal pulses following an abdominal aortic aneurysm repair raises concerns about compromised blood flow, which could lead to serious complications like ischemia or thrombosis. Evaluating and confirming the presence or absence of pulses is crucial to guide further interventions. Elevating extremities on pillows (Choice A) may be beneficial for managing edema, but it is not the immediate priority when pulses are not palpable. Evaluating edema for pitting (Choice B) can provide additional information about fluid status but does not address the primary concern of absent pulses. Wrapping the feet with warmed blankets (Choice D) is not appropriate in this situation and may not address the underlying vascular issue.

4. A client with a diagnosis of hypothermia is being admitted to the hospital by a nurse. Which of the following signs does the nurse anticipate that this client will exhibit?

• A. Increased heart rate and increased blood pressure
• B. Increased heart rate and decreased blood pressure
• C. Decreased heart rate and increased blood pressure
• D. Decreased heart rate and decreased blood pressure

Correct answer: D

Rationale: Hypothermia decreases the heart rate and blood pressure due to reduced metabolic needs of the body. With lower metabolic demands, the heart's workload decreases, leading to reductions in both heart rate and blood pressure. Choices A, B, and C are incorrect because hypothermia typically results in a decrease in heart rate and blood pressure, not an increase.

5. A client taking furosemide (Lasix) reports difficulty sleeping. What question is important for the nurse to ask the client?

• A. What dose of medication are you taking?
• B. Are you eating foods rich in potassium?
• C. Have you lost weight recently?
• D. At what time do you take your medication?

Correct answer: D

Rationale: The nurse needs to determine at what time of day the client takes the Lasix. Due to the diuretic effect of Lasix, clients should take the medication in the morning to prevent nocturia, which may be contributing to the sleep difficulties. Asking about the dose of medication (Choice A) is important but addressing the timing of intake is more crucial in this situation. Inquiring about potassium-rich foods (Choice B) is relevant for clients on potassium-sparing diuretics. Weight loss (Choice C) may be relevant for monitoring the client's overall health but is not directly related to the sleep issue in this case.

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