Nursing Elites

1. A client is returning home after arthroscopy of the shoulder. The nurse should tell the client:

• A. To resume full activity the next day
• B. Not to eat or drink anything until the next morning
• C. To keep the shoulder completely immobilized for the rest of the day
• D. To report to the physician the development of fever or redness and heat at the site

Correct answer: D

Rationale: After arthroscopy, it is important for the client to report any signs of infection, such as the development of fever or redness and heat at the site, to the physician promptly. Options A, B, and C are incorrect. The client should not resume full activity the next day as rest and limited movement are usually recommended post-arthroscopy. It is not necessary to withhold food or fluids until the next morning; the client may resume the usual diet immediately unless otherwise instructed. While immobilization may be recommended for a period, keeping the shoulder completely immobilized for the rest of the day is not typically necessary post-arthroscopy.

2. A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects?

• A. Hypercalcemia.
• B. Hypocalcemia.
• C. Hyperglycemia.
• D. Hypoglycemia.

Correct answer: A

Rationale: Corrected Question: A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects? Rationale: The correct answer is A, Hypercalcemia. Calcium acetate (PhosLo) is a medication used to lower phosphate levels in patients with chronic renal failure. It works by binding with dietary phosphate and preventing its absorption. However, this can lead to an excess of calcium in the blood, causing hypercalcemia. Therefore, the nurse should closely monitor the client for signs and symptoms of elevated calcium levels, such as nausea, vomiting, confusion, and muscle weakness. Choices B, C, and D are incorrect as calcium acetate does not typically cause hypocalcemia, hyperglycemia, or hypoglycemia.

3. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?

• A. Drugs with a broad spectrum
• B. Drugs with a narrow spectrum
• C. Drugs with a broad therapeutic index
• D. Drugs with a narrow therapeutic index

Correct answer: D

Rationale: Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels. Drugs with a narrow spectrum (Choice B) are antibiotics that target only a limited group of bacteria, not related to the need for peak and trough monitoring. Drugs with a broad spectrum (Choice A) cover a wide range of bacteria, but this characteristic does not determine the need for peak and trough monitoring. Drugs with a broad therapeutic index (Choice C) have a wide safety margin between therapeutic and toxic doses, so they typically do not require peak and trough level monitoring.

4. How can a nurse best help a client undergoing a bone marrow aspiration and biopsy, along with two upset family members, manage anxiety during the procedure?

• A. Allow the client's family to stay for emotional support.
• B. Accompany the client silently.
• C. Encourage the client to take slow, deep breaths to promote relaxation.
• D. Provide the client an opportunity to verbalize emotions.

Correct answer: C

Rationale: Encouraging the client to take slow, deep breaths is an effective way for the nurse to help the client manage anxiety during the bone marrow aspiration and biopsy procedure. Slow, deep breathing can promote relaxation and help reduce anxiety levels. Choice A, allowing the client's family to stay for emotional support, may provide comfort but does not address a direct intervention to help manage anxiety. Choice B, staying with the client silently, may not actively help the client address their anxiety. Choice D, allowing the client to express feelings, is important but may not directly address anxiety management during the procedure.

5. A client has a long history of hypertension. Which category of medication would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

• A. Antibiotic
• B. Histamine blocker
• C. Bronchodilator
• D. Angiotensin-converting enzyme (ACE) inhibitor

Correct answer: D

Rationale: The correct answer is D, Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By blocking this conversion, ACE inhibitors promote vasodilation and improve perfusion to the kidneys. Additionally, ACE inhibitors block the breakdown of bradykinin and prostaglandin, further contributing to vasodilation. They also lead to increased renin and decreased aldosterone levels. These effects help in reducing blood pressure and protecting the kidneys in clients with hypertension. Antibiotics are used to fight infections, histamine blockers reduce inflammation, and bronchodilators widen the bronchi, none of which address the underlying processes involved in slowing the progression of chronic kidney disease (CKD) in hypertensive clients.

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