Nursing Elites

1. A patient with pre-dialysis end-stage kidney disease is asking for dietary recommendations. What should the nurse suggest?

• A. Limit protein intake
• B. Limit potassium intake
• C. Restrict sodium intake
• D. Limit phosphorus intake to 700mg/day

Correct answer: D

Rationale: In patients with pre-dialysis end-stage kidney disease, it is crucial to limit phosphorus intake to 700mg/day to manage their condition. High phosphorus levels can lead to complications such as bone and heart problems. Limiting protein intake is essential in later stages of kidney disease, particularly in dialysis patients to reduce the buildup of waste products. While limiting potassium and restricting sodium intake are also important in kidney disease management, the priority for a patient with pre-dialysis end-stage kidney disease is to control phosphorus levels.

2. A nurse is caring for a client who is hyperventilating and has the following ABG results: pH 7.50, PaCO2 29 mm Hg, and HCO3- 25 mEq/L. The nurse should recognize that the client has which of the following acid-base imbalances?

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

Correct answer: B

Rationale: The correct answer is B: Respiratory alkalosis. In this scenario, the client is experiencing respiratory alkalosis due to hyperventilation. Hyperventilation leads to excessive loss of carbon dioxide, causing a decrease in hydrogen ion concentration and an increase in pH levels. Choices A, C, and D are incorrect. Respiratory acidosis is characterized by high PaCO2 and low pH. Metabolic acidosis is associated with low HCO3- levels and low pH. Metabolic alkalosis is marked by high HCO3- levels and high pH. In this case, the ABG results indicate respiratory alkalosis.

3. What is the first intervention for a patient admitted with unstable angina?

• A. Administer nitroglycerin
• B. Obtain cardiac enzymes
• C. Start IV fluids
• D. Monitor for chest pain

Correct answer: A

Rationale: The correct first intervention for a patient admitted with unstable angina is to administer nitroglycerin. Nitroglycerin helps to relieve chest pain by dilating blood vessels and increasing blood flow to the heart, thereby reducing cardiac workload. This intervention aims to alleviate symptoms and prevent further cardiac damage. Obtaining cardiac enzymes (Choice B) is important for diagnosing a myocardial infarction but is not the initial intervention for unstable angina. Starting IV fluids (Choice C) may be indicated in specific cases like hypovolemia but is not the primary intervention for unstable angina. Monitoring for chest pain (Choice D) is essential but taking action to alleviate the pain, like administering nitroglycerin, is the primary focus in the initial management of unstable angina.

4. What action should a healthcare provider take if a patient reports cramping during enema administration?

• A. Lower the height of the solution container
• B. Increase the flow of the enema solution
• C. Stop the procedure and remove the tubing
• D. Continue the enema at a slower rate

Correct answer: A

Rationale: When a patient reports cramping during enema administration, the best action is to lower the height of the enema solution container. This adjustment helps relieve abdominal cramping by slowing down the flow of the enema, making it more comfortable for the patient. Increasing the flow of the solution (choice B) would exacerbate the cramping. Stopping the procedure and removing the tubing (choice C) may be necessary in some cases but should not be the first response to cramping. Continuing the enema at a slower rate (choice D) might not be as effective as lowering the height of the solution container in addressing the cramping.

5. What intervention should be done if continuous bubbling is seen in the chest tube water seal chamber?

• A. Tighten the connections of the chest tube system
• B. Replace the chest tube system
• C. Clamp the chest tube
• D. Continue monitoring the chest tube

Correct answer: A

Rationale: When continuous bubbling is observed in the chest tube water seal chamber, the appropriate intervention is to tighten the connections of the chest tube system. This step helps address an air leak in the system, which could compromise its effectiveness. Choice B (Replace the chest tube system) is not the initial step and may be unnecessary if the issue can be resolved by tightening connections. Choice C (Clamp the chest tube) is incorrect as clamping the chest tube could lead to a dangerous increase in pressure within the system. Choice D (Continue monitoring the chest tube) is also not the best immediate action to take when continuous bubbling is present, as prompt intervention is needed to prevent complications.

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