Nursing Elites

1. A client with a history of calcium phosphate urinary stones is being taught by a nurse. Which statements should the nurse include in this client’s dietary teaching? (Select all that apply.)

• A. Limit your intake of food high in animal protein.
• B. Read food labels to help minimize your sodium intake.
• C. A and B
• D. Reduce your intake of milk and other dairy products.

Correct answer: C

Rationale: For a client with a history of calcium phosphate urinary stones, it is essential to limit the intake of foods high in animal protein to prevent the formation of stones. Additionally, reducing sodium intake is crucial as high sodium levels can contribute to stone formation. Therefore, choices A and B are correct. Choice D, which suggests reducing intake of milk and other dairy products, is not specifically recommended for calcium phosphate stones. Clients with calcium phosphate stones should focus on limiting animal protein, sodium, and calcium intake. Choices A and B address these dietary modifications, making them the correct options for this client. Choices D, which is not directly related to calcium phosphate stones, is incorrect.

2. The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?

• A. You may take antacids with levofloxacin to decrease gastrointestinal upset.
• B. You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain.
• C. You should monitor your serum glucose more closely while taking levofloxacin.
• D. You should take levofloxacin on an empty stomach to improve absorption.

Correct answer: C

Rationale: Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely.

3. A client with chronic kidney disease starts on hemodialysis. During the first dialysis treatment, the client's blood pressure drops from 150/90 to 80/30. Which action should the nurse take first?

• A. Stop the dialysis treatment
• B. Administer 5% albumin IV
• C. Monitor blood pressure every 45 minutes
• D. Lower the head of the chair and elevate feet

Correct answer: D

Rationale: The initial action the nurse should take when a client's blood pressure drops significantly during hemodialysis is to lower the head of the chair and elevate the feet. This position adjustment helps improve blood flow to the brain and vital organs, assisting in stabilizing blood pressure. Stopping the dialysis treatment immediately may not be necessary if the blood pressure can be managed effectively by position changes. Administering 5% albumin IV is not the first-line intervention for hypotension during dialysis. Monitoring blood pressure every 45 minutes is important but not the immediate action needed to address the significant drop in blood pressure observed during the dialysis session.

4. The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/hour. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take?

• A. Decrease the IV fluid rate and notify the provider.
• B. Increase the IV fluid rate and notify the provider.
• C. Request an order for a colloidal IV solution.
• D. Request an order for a hypertonic IV solution.

Correct answer: A

Rationale: The patient is showing signs of fluid volume excess, indicated by crackles in both lungs, increased heart rate, and elevated blood pressure. To address this, the nurse should decrease the IV fluid rate and notify the provider. Increasing the IV fluid rate would worsen fluid overload. Requesting colloidal or hypertonic IV solutions would exacerbate the issue by pulling more fluids into the intravascular space, leading to further volume overload.

5. A pregnant client tells the nurse, “I am experiencing a burning pain when I urinate.” How should the nurse respond?

• A. This means labor will start soon. Prepare to go to the hospital.
• B. You probably have a urinary tract infection. Drink more cranberry juice.
• C. Make an appointment with your provider to have your infection treated.
• D. Your pelvic wall is weakening. Pelvic muscle exercises should help.

Correct answer: C

Rationale: Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. Choice A is incorrect because burning pain during urination does not signify the start of labor. Choice B is incorrect because while cranberry juice may help prevent urinary tract infections, it is not a treatment. Choice D is incorrect because burning pain when urinating is not indicative of weakening pelvic muscles.

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