Nursing Elites

1. An elderly client seems confused and reports the onset of nausea, dysuria, and urgency with incontinence. Which action should the nurse implement?

• A. Auscultate for renal bruits
• B. Obtain a clean catch mid-stream specimen
• C. Use a dipstick to measure for urinary ketones
• D. Begin to strain the client's urine

Correct answer: B

Rationale: This elderly client is presenting symptoms consistent with a urinary tract infection (UTI), such as confusion, nausea, dysuria, urgency, and incontinence. The best course of action for the nurse is to obtain a clean catch mid-stream specimen. This specimen will help identify the causative agent of the UTI, allowing for targeted treatment with an appropriate anti-infective agent. Auscultating for renal bruits (Choice A) is not indicated in this scenario as the client's symptoms point towards a UTI rather than a renal issue. Using a dipstick to measure for urinary ketones (Choice C) is not relevant in the context of UTI symptoms. Beginning to strain the client's urine (Choice D) would not address the need to identify the causative agent for targeted treatment.

2. A client with a history of atrial fibrillation is admitted with a new onset of confusion. Which intervention should the nurse implement first?

• A. Obtain a blood glucose level.
• B. Administer an anticoagulant as prescribed.
• C. Perform a neurological assessment.
• D. Administer aspirin as prescribed.

Correct answer: C

Rationale: Performing a neurological assessment is the priority in this situation as it helps in evaluating the cause of the new onset of confusion in a client with atrial fibrillation. This assessment will provide crucial information about the client's neurological status, which can guide further interventions. Obtaining a blood glucose level (Choice A) is important but should not be the first step when dealing with a new onset of confusion. Administering an anticoagulant (Choice B) or aspirin (Choice D) may be necessary depending on the underlying cause, but assessing the neurological status comes first to determine the appropriate course of action.

3. A client who had a gestational trophoblastic disease (GTD) evacuated 2 days ago is being... What intervention is most important for the nurse to implement?

• A. Teach the client about the use of a home pregnancy test.
• B. Schedule weekly home visits to draw hCG values.
• C. Schedule a 5-week follow-up with the healthcare provider.
• D. Begin chemotherapy administration during the first home visit.

Correct answer: B

Rationale: The most important intervention for the nurse to implement is to schedule weekly home visits to draw hCG values. Monitoring hCG levels is crucial in detecting potential complications like choriocarcinoma following GTD evacuation. Teaching about home pregnancy tests (Choice A) may not be as immediate and critical as monitoring hCG levels. A 5-week follow-up appointment (Choice C) may be too delayed for close monitoring. Initiating chemotherapy (Choice D) without appropriate hCG monitoring and evaluation is not recommended as the first-line intervention.

4. A client is admitted with a diagnosis of septic shock. Which clinical finding requires immediate intervention?

• A. Blood pressure of 90/60 mmHg
• B. Temperature of 100.4°F
• C. Heart rate of 120 beats per minute
• D. Urine output of 30 ml/hour

Correct answer: C

Rationale: In a client with septic shock, a heart rate of 120 beats per minute is a critical clinical finding that requires immediate intervention. A rapid heart rate can indicate worsening sepsis and inadequate tissue perfusion. Correcting the underlying cause of the tachycardia and stabilizing the heart rate is crucial in managing septic shock. The other options, while important, do not represent an immediate threat to the patient's condition. A blood pressure of 90/60 mmHg may be expected in septic shock, a temperature of 100.4°F is mildly elevated, and a urine output of 30 ml/hour, though decreased, may not be an immediate concern in the context of septic shock.

5. The mother of an adolescent tells the clinic nurse, 'My son has athlete's foot. I have been applying triple antibiotic ointment for two days, but there has been no improvement.' What instruction should the nurse provide?

• A. Antibiotics take two weeks to become effective against fungal infections like athlete's foot.
• B. Continue using the ointment for a full week, even after the symptoms disappear.
• C. Applying too much ointment can reduce its effectiveness. Apply a thin layer to prevent maceration.
• D. Stop using the ointment and encourage complete drying of the feet and wearing clean socks.

Correct answer: D

Rationale: The correct answer is D. Athlete's foot (tinea pedis) is a fungal infection, not a bacterial infection that would respond to antibiotics. The primary management involves keeping the feet well-ventilated, dry after bathing, and wearing clean socks to prevent moisture buildup, which promotes fungal growth. Using an antibiotic ointment like triple antibiotic ointment is not effective for treating athlete's foot. Therefore, the nurse should advise the mother to stop using the antibiotic ointment and focus on promoting proper foot hygiene to manage the fungal infection. Choices A, B, and C are incorrect as they do not address the fungal nature of athlete's foot and the ineffectiveness of antibiotic ointments in its treatment.

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