Nursing Elites

1. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient’s provider to order

• A. a broad-spectrum antibiotic.
• B. a narrow-spectrum antibiotic.
• C. multiple antibiotics.
• D. the pneumococcal vaccine.

Correct answer: A

Rationale: In this scenario where the offending organism causing pneumonia is unknown due to the inability to produce sputum for culture, the appropriate choice is a broad-spectrum antibiotic. Broad-spectrum antibiotics are effective against a wide range of bacteria and are commonly used when the specific pathogen is unidentified. Narrow-spectrum antibiotics target specific types of bacteria and are chosen based on culture and sensitivity results. Using multiple antibiotics without a clear indication from culture and sensitivity testing can lead to antibiotic resistance and is not recommended in this situation. Additionally, the pneumococcal vaccine is preventive and does not treat an ongoing infection like pneumonia.

2. A client recovering from surgery has a large abdominal wound. Which of the following foods, high in vitamin C, should the nurse encourage the client to eat to promote wound healing?

• A. Steak
• B. Veal
• C. Cheese
• D. Oranges

Correct answer: D

Rationale: Oranges are a rich source of vitamin C, which is essential for wound healing due to its role in collagen synthesis. Citrus fruits like oranges, as well as other fruits and vegetables such as strawberries, kiwi, bell peppers, and broccoli, are high in vitamin C. Meats like steak and veal are not significant sources of vitamin C; they are primarily sources of protein. Cheese is not a good source of vitamin C but does provide calcium and protein.

3. The client with chronic kidney disease (CKD) is being taught about the necessary sodium restriction in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

• A. I am thrilled that I can continue to eat fast food.
• B. I will cut out bacon with my eggs every morning.
• C. My cooking style will change by not adding salt.
• D. I will probably lose weight by cutting out potato chips.

Correct answer: A

Rationale: Choice A, 'I am thrilled that I can continue to eat fast food,' indicates a lack of understanding as fast food is typically high in sodium, which is detrimental for individuals with CKD. The client should be advised to avoid fast food due to its high sodium content. Choices B, C, and D demonstrate a good understanding of the need for sodium restriction in the diet to prevent complications associated with CKD. Cutting out bacon, avoiding salt in cooking, and eliminating high-sodium snacks like potato chips are all positive steps towards managing CKD.

4. A client who had a C-5 spinal cord injury 2 years ago is admitted to the emergency department with the diagnosis of autonomic dysreflexia secondary to a full bladder. Which assessment finding should the nurse expect this client to exhibit?

• A. Complaints of chest pain and shortness of breath
• B. Hypotension and venous pooling in the extremities
• C. Profuse diaphoresis and severe, pounding headache
• D. Pain and burning sensation upon urination and hematuria

Correct answer: C

Rationale: Autonomic dysreflexia is a life-threatening condition commonly seen in clients with spinal cord injuries above the T6 level. It is characterized by a sudden onset of excessively high blood pressure due to a noxious stimulus below the level of injury, often a distended bladder. The exaggerated sympathetic response leads to vasoconstriction, resulting in symptoms such as profuse diaphoresis (sweating) and a severe, pounding headache. These symptoms are the body's attempt to lower blood pressure. Complaints of chest pain and shortness of breath (Choice A) are not typical findings in autonomic dysreflexia. Hypotension and venous pooling (Choice B) are opposite manifestations of autonomic dysreflexia, which is characterized by hypertension. Pain and burning sensation upon urination and hematuria (Choice D) are indicative of a urinary tract infection and not specific to autonomic dysreflexia.

5. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to

• A. not take a potassium supplement daily.
• B. recognize that abdominal cramping is a common side effect.
• C. report decreased urine output to the provider.
• D. take these medications in the morning.

Correct answer: C

Rationale: When combining a potassium-sparing diuretic like spironolactone with a thiazide diuretic, there is an increased risk of hyperkalemia, especially in patients with poor renal function. Therefore, the patient should be educated to report any decrease in urine output, which could indicate a potential issue with kidney function. Choice A is incorrect because taking additional potassium supplements can further increase the risk of hyperkalemia. Choice B is incorrect as abdominal cramping is not a common side effect of spironolactone. Choice D is incorrect because the timing of medication administration is not directly related to the addition of spironolactone and thiazide diuretic; there is no specific recommendation to take these medications only at bedtime.

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