Nursing Elites

1. A healthcare professional is monitoring the respiratory status of a client who has just undergone surgery and is wearing a pulse oximeter. Which of the following coexisting problems is cause for the healthcare professional to suspect that the oxygen saturation readings are not entirely accurate?

• A. Infection
• B. Hypertension
• C. Low blood pressure
• D. Loss of cough reflex

Correct answer: C

Rationale: Low blood pressure (hypotension), shock, and the use of peripheral vasoconstricting medications can lead to inaccurate pulse oximetry readings due to impaired peripheral perfusion. Hypertension and infection are not typically associated with inaccurate pulse oximetry readings, while the loss of cough reflex does not directly affect oxygen saturation readings.

2. The patient is being educated on taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?

• A. I may need additional sodium and calcium while taking this medication.
• B. I should consume plenty of fruits and vegetables while taking this drug.
• C. I should be cautious when getting up from a bed or chair while on this medication.
• D. I will take the medication in the morning to reduce certain side effects.

Correct answer: A

Rationale: The correct answer is A because patients do not require extra sodium or calcium while taking hydrochlorothiazide, a thiazide diuretic. This medication actually promotes the excretion of sodium and water. Choices B, C, and D are correct statements regarding the use of hydrochlorothiazide. Patients are encouraged to have a diet rich in fruits and vegetables, be careful with position changes due to potential orthostatic hypotension, and take the medication in the morning to reduce the need for frequent urination during nighttime.

3. A client with bladder cancer who underwent a complete cystectomy with ileal conduit is being assessed by a nurse. Which assessment finding should prompt the nurse to urgently contact the healthcare provider?

• A. The ileostomy is draining blood-tinged urine.
• B. There is serous sanguineous drainage on the surgical dressing.
• C. The ileostomy stoma appears pale and cyanotic.
• D. Oxygen saturations are 92% on room air.

Correct answer: C

Rationale: A pale or cyanotic appearance of the ileostomy stoma indicates compromised circulation, which can lead to necrosis if not promptly addressed. On the other hand, blood-tinged urine and serous sanguineous drainage are common following a complete cystectomy with ileal conduit. These findings do not typically indicate an urgent issue. An oxygen saturation of 92% on room air is slightly below the normal range but does not warrant urgent healthcare provider contact unless accompanied by significant respiratory distress or other concerning symptoms.

4. In a 46-year-old female client admitted for acute renal failure secondary to diabetes and hypertension, which test is the best indicator of adequate glomerular filtration?

• A. Serum creatinine.
• B. Blood urea nitrogen (BUN).
• C. Sedimentation rate.
• D. Urine specific gravity.

Correct answer: A

Rationale: The correct answer is A: Serum creatinine. Creatinine is a product of muscle metabolism that is filtered by the glomerulus. Blood levels of creatinine are not affected by dietary or fluid intake, making it a reliable indicator of kidney function. An elevated creatinine level strongly suggests nephron loss, indicating decreased glomerular filtration rate. Choice B, Blood Urea Nitrogen (BUN), reflects the amount of urea nitrogen in the blood and can be influenced by factors other than kidney function, such as protein intake and liver health, making it less specific for evaluating glomerular filtration. Choice C, Sedimentation rate, is a measure of how quickly red blood cells settle in a test tube and is not a direct marker of kidney function. Choice D, Urine specific gravity, mainly reflects the kidney's ability to concentrate urine and is not a direct indicator of glomerular filtration rate. Therefore, Serum creatinine is the most appropriate test to assess glomerular filtration in this scenario.

5. A client is being discharged after lithotripsy for a urinary calculus. Which statements should the nurse include in the discharge teaching? (Select all that apply.)

• A. Finish the prescribed antibiotic even if you are feeling better.
• B. Drink at least 3 liters of fluid each day.
• C. The bruising on your back may take several weeks to resolve.
• D. All of the above

Correct answer: D

Rationale: After lithotripsy for a urinary calculus, it is important for the client to complete the prescribed antibiotic course to prevent urinary tract infections. Drinking at least 3 liters of fluid daily helps dilute stone-forming crystals, prevent dehydration, and promote urine flow. Bruising on the back may occur after the procedure and can take several weeks to resolve. Additionally, the client may experience blood in the urine for several days post-procedure. Reporting any pain, fever, chills, or urination difficulties to the healthcare provider is essential, as these symptoms could indicate infection or stone formation. Choice D is correct as all the statements are appropriate for the client's discharge teaching. Choices A, B, and C are individually correct based on the rationale provided, making D the correct answer.

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