Nursing Elites

1. A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

• A. Encourage the client to drink more fluids.
• B. Contact the provider and recommend a low-sodium diet.
• C. Prepare to administer an intravenous diuretic.
• D. Obtain a suction device and implement seizure precautions.

Correct answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

2. 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.

3. A healthcare professional reviews the blood gas results of a client in respiratory distress. The pH is 7.32, and the PCO2 is 50 mm Hg. Which of the following acid-base imbalances does the professional recognize in these findings?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: C

Rationale: In respiratory acidosis, the pH is low (<7.35) and the PCO2 is increased (>45 mm Hg). These findings indicate that the client is experiencing respiratory acidosis, a condition where there is an excess of carbon dioxide in the blood due to inadequate ventilation, commonly seen in respiratory distress. Metabolic acidosis (Choice A) is characterized by a low pH and decreased bicarbonate levels, which is not the case in this scenario. Metabolic alkalosis (Choice B) is associated with a high pH and increased bicarbonate levels. Respiratory alkalosis (Choice D) is marked by a high pH and decreased PCO2, opposite to the values presented in the blood gas results of this client.

4. The healthcare provider prescribes diagnostic tests for a client with pneumonia identified on a chest X-ray. Which diagnostic test should the nurse review for implementation to guide the most therapeutic treatment of pneumonia?

• A. Sputum culture and sensitivity
• B. Blood cultures
• C. Arterial blood gases (ABG)
• D. Computerized tomography (CT) of the chest

Correct answer: A

Rationale: Sputum culture and sensitivity is the most appropriate diagnostic test for pneumonia as it helps in identifying the causative organism, which is crucial for guiding the selection of the most effective antibiotic therapy. Blood cultures (choice B) are more useful in identifying systemic infections rather than pneumonia specifically. Arterial blood gases (ABG) (choice C) are helpful in assessing oxygenation but do not directly aid in identifying the causative organism. Computerized tomography (CT) of the chest (choice D) is useful for evaluating structural abnormalities in the lungs but is not the initial test of choice for diagnosing pneumonia.

5. Which of the following is a priority intervention for a patient with heart failure?

• A. Administering diuretics.
• B. Administering oxygen.
• C. Administering beta-blockers.
• D. Administering vasodilators.

Correct answer: B

Rationale: Administering oxygen is a priority intervention in heart failure because it helps improve oxygenation, alleviate hypoxemia, and reduce the workload on the heart. Oxygen therapy is crucial in managing acute heart failure exacerbations. While diuretics (Choice A) are commonly used in heart failure to reduce fluid overload, administering oxygen takes precedence due to its immediate impact on oxygen delivery. Beta-blockers (Choice C) and vasodilators (Choice D) are also important in heart failure management, but in the acute setting, ensuring adequate oxygen supply is the priority.

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