Nursing Elites

1. A postmenopausal client asks the nurse why she is experiencing discomfort during intercourse. What response is best for the nurse to provide?

• A. Estrogen deficiency causes the vaginal tissues to become dry and thinner.
• B. Infrequent intercourse results in the vaginal tissues losing their elasticity.
• C. Dehydration from inadequate fluid intake causes vulva tissue dryness.
• D. Lack of adequate stimulation is the most common reason for dyspareunia.

Correct answer: A

Rationale: Estrogen deficiency in postmenopausal clients leads to a decrease in the moisture-secreting capacity of vaginal cells. This results in vaginal tissues becoming thinner, drier, and smoother, which reduces vaginal stretching and contributes to discomfort during intercourse. Choice B is incorrect because the primary reason for discomfort is not infrequent intercourse but rather physiological changes due to estrogen deficiency. Choice C is incorrect as dehydration may cause dryness but is not the primary reason for discomfort in this scenario. Choice D is incorrect as lack of stimulation is not the most common reason for dyspareunia in postmenopausal clients; estrogen deficiency is the key factor.

2. What is a key intervention for a patient with diabetic ketoacidosis (DKA)?

• A. Administering insulin
• B. Administering IV fluids
• C. Administering oral glucose
• D. Administering oral fluids

Correct answer: A

Rationale: Administering insulin is a crucial intervention for a patient with diabetic ketoacidosis (DKA) because it helps in managing hyperglycemia and ketosis by promoting the uptake of glucose by cells and inhibiting the production of ketones. IV fluids are necessary to correct dehydration and electrolyte imbalances commonly seen in DKA but are not the primary treatment for the condition. Administering oral glucose would exacerbate hyperglycemia in a patient with DKA, while administering oral fluids alone would not effectively address the underlying metabolic disturbances seen in DKA.

3. A client is being prepared for a colonoscopy. Into which position does the nurse assist the client for the procedure?

• A. Left Sims' position
• B. Lithotomy position
• C. Knee-chest position
• D. Right Sims' position

Correct answer: A

Rationale: During a colonoscopy, the client is positioned in the left Sims' position. This position is chosen as it optimally utilizes the client’s anatomy to facilitate the introduction of the colonoscope. The lithotomy position (Choice B) is commonly used for gynecological exams, not colonoscopies. The knee-chest position (Choice C) is typically employed for rectal examinations or certain surgical procedures, not colonoscopies. The right Sims' position (Choice D) is a less common position for colonoscopy compared to the left Sims' position.

4. A client who has undergone pleural biopsy is being monitored by a nurse. Which finding indicates a potential complication for the client?

• A. Warm, dry skin
• B. Mild pain at the biopsy site
• C. Complaints of shortness of breath
• D. Capillary refill time of less than 3 seconds

Correct answer: C

Rationale: Complaints of shortness of breath are a concerning finding post-pleural biopsy, as they may indicate a complication such as a pneumothorax or hemothorax. Shortness of breath can be a sign of respiratory distress that requires immediate attention. Warm, dry skin, mild pain at the biopsy site, and a capillary refill time of less than 3 seconds are not typically associated with immediate complications following a pleural biopsy. Warm, dry skin may be a normal finding, mild pain can be expected at the biopsy site, and a capillary refill time of less than 3 seconds is within normal limits.

5. A client has made an appointment for her annual Papanicolaou test (a.k.a. Pap smear). The nurse who schedules the appointment should tell the client that:

• A. The test cannot be performed while the client is menstruating
• B. Vaginal douching is required at least 24 hours before the test
• C. Spicy foods should not be eaten on the day of the test
• D. The test has absolutely no discomfort associated with it

Correct answer: A

Rationale: The correct answer is A. A Pap smear cannot be performed with accurate results during menstruation. Menstrual blood may interfere with the test results. Choice B is incorrect as vaginal douching should be avoided for at least 24 hours before the test to prevent altering the cervical cells. Choice C is incorrect as there is no restriction on spicy foods before a Pap smear. Choice D is incorrect as some women may experience mild discomfort during the test, although it is generally well-tolerated.

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