Nursing Elites

1. A client is being prepared for a colonoscopy. Into which position does the nurse assist the client for the procedure?

• A. Left Sims' position
• B. Lithotomy position
• C. Knee-chest position
• D. Right Sims' position

Correct answer: A

Rationale: During a colonoscopy, the client is positioned in the left Sims' position. This position is chosen as it optimally utilizes the client’s anatomy to facilitate the introduction of the colonoscope. The lithotomy position (Choice B) is commonly used for gynecological exams, not colonoscopies. The knee-chest position (Choice C) is typically employed for rectal examinations or certain surgical procedures, not colonoscopies. The right Sims' position (Choice D) is a less common position for colonoscopy compared to the left Sims' position.

2. A client with peripheral arterial disease (PAD) has cool and pale feet with diminished pulses. Which of the following interventions should the nurse implement?

• A. Keep the legs elevated above the level of the heart.
• B. Encourage the client to exercise daily.
• C. Apply warm compresses to the affected area.
• D. Apply ice packs to the affected area.

Correct answer: C

Rationale: In peripheral arterial disease (PAD), there is decreased blood flow to the extremities. Applying warm compresses helps dilate blood vessels, improve circulation, and relieve symptoms. Elevating the legs above the heart level may further compromise blood flow. Encouraging daily exercise is important in PAD management but may not be appropriate when the client has cool, pale feet with diminished pulses. Applying ice packs can worsen vasoconstriction and further reduce blood flow, exacerbating symptoms in PAD.

3. A client with Diabetes Insipidus (DI) is being cared for by a nurse. Which data warrants the most immediate intervention by the nurse?

• A. Serum sodium of 185 mEq/L (185 mmol/L)
• B. Dry skin with poor skin turgor
• C. Apical rate of 110 beats per minute
• D. Polyuria and excessive thirst

Correct answer: A

Rationale: A serum sodium level of 185 mEq/L (185 mmol/L) is dangerously high and indicates severe dehydration, requiring immediate intervention to prevent neurological damage. The other options are not as critical as high serum sodium levels, which can lead to serious complications such as seizures, coma, and death if not promptly addressed. Dry skin with poor skin turgor and polyuria with excessive thirst are common findings in clients with Diabetes Insipidus and should be managed but do not pose an immediate threat to the client's life. An apical heart rate of 110 beats per minute may indicate tachycardia, which could be related to dehydration but is not as urgent as addressing the severe hypernatremia.

4. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take this medication with food and plenty of water.
• B. I shall keep my appointment at the infusion center each week.
• C. I’ll limit my intake of green leafy vegetables while on this medication.
• D. I must not take this medication if I have an infection or am feeling ill.

Correct answer: B

Rationale: The correct answer is B. Temsirolimus, also known as Torisel, is administered as a weekly intravenous infusion. This medication blocks protein needed for cell division, inhibiting cell cycle progression. It is not taken orally, so there is no need to take it with food or water. Keeping the weekly infusion center appointment is crucial for the client to receive the prescribed treatment effectively. Choice A is incorrect as temsirolimus is not taken with food or water. Choice C is incorrect because there is no need to limit the intake of green leafy vegetables while on this medication. Choice D is incorrect as having an infection or feeling ill does not prohibit the use of temsirolimus.

5. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding would the nurse consider an indication of progressive hepatic encephalopathy?

• A. An increase in abdominal girth.
• B. Hypertension and a bounding pulse.
• C. Decreased bowel sounds.
• D. Difficulty in handwriting.

Correct answer: D

Rationale: Difficulty in handwriting is a common early sign of hepatic encephalopathy. Changes in handwriting can indicate progression or reversal of hepatic encephalopathy leading to coma. Choice (A) is a sign of ascites, not hepatic encephalopathy. Hypertension and a bounding pulse (Choice B) are not typically associated with hepatic encephalopathy. Decreased bowel sounds (Choice C) do not directly indicate an increase in serum ammonia level, which is the primary cause of hepatic encephalopathy.

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