Nursing Elites

1. After educating a client with a history of renal calculi, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I should drink at least 3 liters of fluid every day.
• B. I will eliminate all dairy or sources of calcium from my diet.
• C. Aspirin and aspirin-containing products can lead to stones.
• D. The doctor can give me antibiotics at the first sign of a stone.

Correct answer: A

Rationale: To prevent the formation of renal calculi, it is essential to maintain adequate hydration as dehydration can contribute to the precipitation of minerals leading to stone formation. Therefore, the correct statement indicating understanding of the teaching is choice A. Increasing fluid intake helps dilute urine and reduces the risk of stone formation. Eliminating all sources of calcium is not recommended as calcium is essential for various bodily functions and eliminating it can lead to other health issues. Aspirin and aspirin-containing products do not directly cause kidney stones. Antibiotics are not used to prevent or treat renal calculi, as they are not caused by bacterial infections.

2. A client with stress incontinence is being taught about pelvic muscle exercises. Which statements should be included by the nurse? (Select all that apply.)

• A. Starting and stopping the urine stream involves using pelvic muscles.
• B. Tighten pelvic muscles for a slow count of 10 and then relax for a slow count of 10.
• C. Pelvic muscle exercises can be performed in various positions: lying down, sitting up, and standing.
• D. A & B

Correct answer: D

Rationale: The correct statements to include when teaching a client with stress incontinence about pelvic muscle exercises are that starting and stopping the urine stream involve using pelvic muscles and that tightening pelvic muscles for a slow count of 10 and then relaxing for a slow count of 10 can help strengthen them. It is essential to highlight that pelvic muscle exercises can be performed in various positions, including lying down, sitting up, and standing. This variety in positions helps engage the muscles effectively. Performing these exercises 15 times in each position can aid in strengthening the pelvic floor muscles. Consistent exercise over several weeks typically leads to improved control over urine leakage. Choice C is incorrect because pelvic muscle exercises can be performed in different positions and are not limited to sitting upright with feet on the floor.

3. A client tells the nurse that he has been experiencing frequent heartburn and has been 'living on antacids.' For which acid-base disturbance does the nurse recognize a risk?

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

Correct answer: B

Rationale: The correct answer is B: Metabolic alkalosis. In this scenario, the client's frequent use of antacids containing alkaline components can lead to an excess of bicarbonate in the body, causing metabolic alkalosis. Oral antacids work by neutralizing stomach acid, potentially leading to an alkaline shift in the body's pH balance. Choices A, C, and D are incorrect. Metabolic acidosis is not typically associated with antacid use. Respiratory acidosis and respiratory alkalosis are related to respiratory system dysfunction rather than antacid ingestion.

4. During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. What action should the nurse take first?

• A. Use a laryngoscope to check for a foreign body lodged in the airway.
• B. Reposition the head to ensure that the airway is properly opened.
• C. Turn the client to the side and administer three back blows.
• D. Perform a finger sweep of the mouth to clear any obstructions.

Correct answer: B

Rationale: The most common reason for inadequate lung aeration during CPR is the incorrect positioning of the head, leading to airway obstruction. Therefore, the initial action should be to reposition the head to open the airway properly and attempt to ventilate again. Using a laryngoscope to check for foreign bodies in the airway (Choice A) is not the first step and could delay crucial interventions. Turning the client to the side and administering back blows (Choice C) is not indicated in this scenario as the focus is on ventilating the lungs. Performing a finger sweep of the mouth (Choice D) is not recommended as it may push obstructions further into the airway during CPR.

5. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program?

• A. A 78-year-old female who is confused
• B. A 65-year-old male with diabetes mellitus
• C. A 52-year-old female with kidney failure
• D. A 47-year-old male with arthritis

Correct answer: A

Rationale: For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from other types of bladder training. A confused client may need structured assistance to establish a regular bathroom routine, which can help manage urge incontinence effectively. Clients with diabetes mellitus, kidney failure, or arthritis may require different strategies tailored to their specific conditions.

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