Nursing Elites

1. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take a laxative every night before going to bed.
• B. I must increase my intake of dietary fiber and fluids.
• C. I shall only use salt when I am cooking my own food.
• D. I’ll eat white bread to minimize gastrointestinal gas.

Correct answer: B

Rationale: Choice B is the correct answer. Clients with PKD often experience constipation, which can be managed by increasing their intake of dietary fiber and fluids. This helps promote bowel regularity. Laxatives should be used cautiously and not as a routine solution. Choice A is incorrect as regular laxative use is not recommended. Choice C is incorrect as a low-salt diet is typically advised for clients with PKD, not just limiting salt while cooking. Choice D is incorrect as white bread is low in fiber and not beneficial for managing constipation, which is common in PKD.

2. A client has a urine specific gravity of 1.040. What action should the nurse take?

• A. Obtain a urine culture and sensitivity.
• B. Place the client on restricted fluids.
• C. Assess the client’s creatinine level.
• D. Increase the client’s fluid intake.

Correct answer: D

Rationale: A urine specific gravity of 1.040 is higher than the normal range (1.005 to 1.030) and can indicate dehydration, decreased kidney blood flow, or the presence of antidiuretic hormone. In this situation, the priority action should be to increase the client's fluid intake to address the high specific gravity. Obtaining a urine culture, placing the client on restricted fluids, or assessing the creatinine level would not directly address the underlying issue of high urine specific gravity caused by dehydration or other factors.

3. A pregnant client tells the nurse, “I am experiencing a burning pain when I urinate.” How should the nurse respond?

• A. This means labor will start soon. Prepare to go to the hospital.
• B. You probably have a urinary tract infection. Drink more cranberry juice.
• C. Make an appointment with your provider to have your infection treated.
• D. Your pelvic wall is weakening. Pelvic muscle exercises should help.

Correct answer: C

Rationale: Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. Choice A is incorrect because burning pain during urination does not signify the start of labor. Choice B is incorrect because while cranberry juice may help prevent urinary tract infections, it is not a treatment. Choice D is incorrect because burning pain when urinating is not indicative of weakening pelvic muscles.

4. 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.

5. A client with chronic renal failure is being treated with sodium polystyrene sulfonate (Kayexalate). The nurse should monitor the client for which of the following?

• A. Hyponatremia.
• B. Hypokalemia.
• C. Hyperkalemia.
• D. Hypocalcemia.

Correct answer: C

Rationale: The correct answer is C: Hyperkalemia. Sodium polystyrene sulfonate (Kayexalate) is used to treat high potassium levels (hyperkalemia) by exchanging sodium ions for potassium ions in the large intestine, which is then eliminated through the feces. Therefore, the nurse should monitor the client for changes in potassium levels to ensure the effectiveness of the treatment. Choices A, B, and D are incorrect because sodium polystyrene sulfonate (Kayexalate) is not associated with causing hyponatremia, hypokalemia, or hypocalcemia.

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