Nursing Elites

1. After teaching a client with nephrotic syndrome and a normal glomerular filtration rate, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the nutritional therapy for this condition?

• A. I must decrease my intake of fat.
• B. I will increase my intake of protein.
• C. A decreased intake of carbohydrates will be required.
• D. An increased intake of vitamin C is necessary.

Correct answer: B

Rationale: In nephrotic syndrome, there is significant renal loss of protein leading to hypoalbuminemia and edema formation. If glomerular filtration is normal or near normal, increased protein loss should be matched by an increased intake of protein. Therefore, the correct statement indicating a correct understanding of the nutritional therapy for this condition is increasing protein intake. Decreasing fat, decreasing carbohydrates, or increasing vitamin C intake is not necessary for addressing the underlying issues associated with nephrotic syndrome.

2. 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.

3. A client is scheduled for a barium swallow (esophagography) in 2 days. The nurse, providing preprocedure instructions, should tell the client to:

• A. Eat a regular supper and breakfast
• B. Remove all metal and jewelry before the test
• C. Expect diarrhea for a few days after the procedure
• D. Take all oral medications as scheduled with milk on the day of the test

Correct answer: B

Rationale: The correct answer is B: 'Remove all metal and jewelry before the test.' Before a barium swallow procedure, the client should fast for 8 to 12 hours to ensure the stomach and intestines are empty for optimal visualization. Removing all metal and jewelry is essential to prevent any interference with x-ray imaging. Choice A is incorrect because the client should fast, not eat supper and breakfast, before the test. Choice C is incorrect as diarrhea is not an expected outcome of a barium swallow. Choice D is incorrect as the client should not take any oral medications with milk on the day of the test to ensure accurate test results.

4. The client with peripheral artery disease has been prescribed clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client states which of the following?

• A. I should not be surprised if I bruise more easily or if my gums bleed a little when brushing my teeth.
• B. It is important to take this medicine with food to enhance its effectiveness and minimize stomach upset.
• C. I should stop taking Plavix if it makes me feel weak and dizzy.
• D. The doctor prescribed this medicine to make my platelets less likely to stick together and help prevent clots from forming.

Correct answer: C

Rationale: The correct answer is C. Weakness, dizziness, and headache are common adverse effects of Plavix and should be reported. It is essential to consult a physician before stopping Plavix as it plays a crucial role in preventing platelets from sticking together and forming clots. Choices A, B, and D are incorrect. Choice A is a common side effect of Plavix and does not indicate a need for further teaching. Choice B is incorrect because taking Plavix with or without food can affect its absorption and effectiveness. Choice D correctly explains the purpose of prescribing Plavix to prevent clot formation.

5. A healthcare professional reviews a client’s laboratory results. Which results from the client’s urinalysis should the healthcare professional identify as normal? (Select all that apply.)

• A. pH: 6
• B. Specific gravity: 1.015
• C. Glucose: negative
• D. All of the above

Correct answer: D

Rationale: In a urinalysis, a pH of 6 is within the normal range (typically between 4.6 and 8); a specific gravity of 1.015 is considered normal (usually ranging between 1.005 to 1.030); and a negative glucose result is also normal. Therefore, choices A, B, and C are correct as they fall within the normal values for a urinalysis. Choices A, B, and C are the correct answers, as the pH, specific gravity, and glucose levels are within the normal range for a urinalysis. Choice D is correct because all the listed values are normal. Choices A, B, and C are the correct options as they meet the criteria for normal urinalysis values. The other choices do not fall within the normal range for a urinalysis.

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