Nursing Elites

1. A patient’s serum osmolality is 305 mOsm/kg. Which term describes this patient’s body fluid osmolality?

• A. Iso-osmolar
• B. Hypo-osmolar
• C. Hyperosmolar
• D. Isotonic

Correct answer: C

Rationale: The correct term to describe a patient with a serum osmolality of 305 mOsm/kg is 'hyperosmolar.' Normal osmolality ranges from 280 to 300 mOsm/kg. A patient with an osmolality above this range is considered hyperosmolar. Choice A ('Iso-osmolar') implies an equal osmolality, which is not the case in this scenario. Choice B ('Hypo-osmolar') suggests a lower osmolality, which is incorrect based on the provided serum osmolality value. Choice D ('Isotonic') refers to a solution having the same osmolality as another solution, not describing the specific scenario of this patient being above the normal range.

2. The client with chronic renal failure is being educated about the importance of a low-sodium diet. Which of the following statements by the client indicates a need for further teaching?

• A. I can eat canned vegetables as long as I rinse them first.
• B. I can use table salt sparingly.
• C. I can eat frozen dinners if they are labeled low-sodium.
• D. I can eat whatever I want as long as I avoid salty foods.

Correct answer: B

Rationale: The correct answer is B. Clients with chronic renal failure need to strictly limit their sodium intake. Advising the client to use table salt sparingly is incorrect as they should avoid table salt altogether to adhere to a low-sodium diet. Choice A is correct as rinsing canned vegetables can help reduce their sodium content. Choice C is correct as consuming frozen dinners labeled low-sodium can be a suitable option. Choice D is incorrect as it implies that avoiding only salty foods is sufficient, when in fact, overall sodium intake needs to be monitored closely.

3. The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect?

• A. Headaches
• B. Hypertension
• C. Hypoglycemia
• D. Superinfection

Correct answer: C

Rationale: When a patient takes oral antidiabetic agents (sulfonylurea) along with sulfonamides like trimethoprim-sulfamethoxazole, it can lead to an increased hypoglycemic effect. Therefore, the nurse should monitor the patient closely for hypoglycemia. Headaches, hypertension, and superinfection are not typically associated with the interaction between sulfonamides and sulfonylureas. Examples of antidiabetic sulfonylurea medications include glipizide, glimepiride, glyburide, tolazamide, and tolbutamide.

4. A 68-year-old client on day 2 after hip surgery has no cardiac history but reports having chest heaviness. The first nursing action should be to:

• A. Inquire about the onset, duration, severity, and precipitating factors of the heaviness.
• B. Administer oxygen via nasal cannula.
• C. Offer pain medication for the chest heaviness.
• D. Inform the physician of the chest heaviness.

Correct answer: A

Rationale: The correct first nursing action when a client reports chest heaviness post-hip surgery is to gather more information through assessment. Inquiring about the onset, duration, severity, and precipitating factors of the heaviness is crucial to determine the cause. This approach helps the nurse to gather essential data to make an informed decision regarding the client's care. Administering oxygen (Choice B) may be indicated based on assessment findings, but it is crucial to assess first. Offering pain medication (Choice C) without further assessment is premature and may mask symptoms. Informing the physician (Choice D) should be done after a thorough assessment to provide comprehensive information for appropriate medical decision-making.

5. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

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