Nursing Elites

1. A nurse reviews the urinalysis of a client and notes the presence of glucose. Which action should the nurse take?

• A. Document findings and continue to monitor the client.
• B. Contact the provider and recommend a 24-hour urine test.
• C. Review the client’s recent dietary selections.
• D. Perform a capillary artery glucose assessment.

Correct answer: D

Rationale: Glucose normally is not found in the urine. The normal renal threshold for glucose is about 220 mg/dL, which means that a person whose blood glucose is less than 220 mg/dL will not have glucose in the urine. A positive finding for glucose on urinalysis indicates high blood sugar. The most appropriate action would be to perform a capillary artery glucose assessment. The client needs further evaluation for this abnormal result; therefore, documenting and continuing to monitor is not appropriate. Requesting a 24-hour urine test or reviewing the client’s dietary selections will not assist the nurse to make a clinical decision related to this abnormality.

2. A client with kidney stones from secondary hyperoxaluria requires medication. Which medication should the nurse anticipate administering?

• A. Phenazopyridine (Pyridium)
• B. Propantheline (Pro-Banthine)
• C. Tolterodine (Detrol LA)
• D. Allopurinol (Zyloprim)

Correct answer: D

Rationale: The correct answer is D: Allopurinol (Zyloprim). Allopurinol is used to treat kidney stones caused by secondary hyperoxaluria. This medication helps prevent the formation of certain types of kidney stones. Choices A, B, and C are incorrect. Phenazopyridine (Pyridium) is given to clients with urinary tract infections, not for kidney stones. Propantheline (Pro-Banthine) is an anticholinergic medication used for treating certain gastrointestinal conditions, not kidney stones. Tolterodine (Detrol LA) is also an anticholinergic with smooth muscle relaxant properties, primarily used to treat overactive bladder conditions, not kidney stones.

3. A client with stress incontinence is being taught about pelvic muscle exercises. Which statements should be included by the nurse? (Select all that apply.)

• A. Starting and stopping the urine stream involves using pelvic muscles.
• B. Tighten pelvic muscles for a slow count of 10 and then relax for a slow count of 10.
• C. Pelvic muscle exercises can be performed in various positions: lying down, sitting up, and standing.
• D. A & B

Correct answer: D

Rationale: The correct statements to include when teaching a client with stress incontinence about pelvic muscle exercises are that starting and stopping the urine stream involve using pelvic muscles and that tightening pelvic muscles for a slow count of 10 and then relaxing for a slow count of 10 can help strengthen them. It is essential to highlight that pelvic muscle exercises can be performed in various positions, including lying down, sitting up, and standing. This variety in positions helps engage the muscles effectively. Performing these exercises 15 times in each position can aid in strengthening the pelvic floor muscles. Consistent exercise over several weeks typically leads to improved control over urine leakage. Choice C is incorrect because pelvic muscle exercises can be performed in different positions and are not limited to sitting upright with feet on the floor.

4. A nurse has a prescription to insert a nasogastric tube into the stomach of an assigned client. Which action should the nurse take to insert the tube safely and easily?

• A. Placing the tube in warm water
• B. Hyperextending the head while inserting the tube
• C. Removing the tube if any resistance to insertion is met
• D. Asking the client to swallow as the tube is being advanced

Correct answer: D

Rationale: The correct action for the nurse to take to insert a nasogastric tube safely and easily is asking the client to swallow as the tube is being advanced. This action helps facilitate the passage of the tube through the esophagus into the stomach. Placing the tube in warm water (Choice A) is not a recommended practice for nasogastric tube insertion. Hyperextending the head (Choice B) can cause discomfort and is not necessary for safe insertion. Removing the tube if resistance is met (Choice C) is incorrect as it may cause harm or discomfort to the client. Asking the client to swallow helps the tube pass more smoothly and comfortably.

5. A nurse plans care for an older adult client. Which interventions should the nurse include in this client’s plan of care to promote kidney health? (Select all that apply.)

• A. Ensure adequate fluid intake.
• B. Leave the bathroom light on at night.
• C. Encourage use of the toilet every 6 hours.
• D. A & B

Correct answer: D

Rationale: The correct interventions to promote kidney health in an older adult client include ensuring adequate fluid intake to maintain hydration and leaving the bathroom light on at night to promote safe ambulation. Adequate hydration supports kidney function and helps prevent urinary tract infections. Encouraging the use of the toilet every 6 hours is not specific to kidney health and may not be individualized to the client's needs. Providing thorough perineal care after each voiding is important for hygiene but not directly related to promoting kidney health. Assessing for urinary retention and urinary tract infections is crucial but falls under assessment rather than interventions for promoting kidney health specifically.

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