Nursing Elites

1. During a clinic visit, a client with a kidney transplant asks, 'What will happen if chronic rejection develops?' Which response is best for the nurse to provide?

• A. Dialysis would need to be resumed if chronic rejection becomes a reality.
• B. Immunosuppressive therapy would be intensified.
• C. A second transplant would be scheduled immediately.
• D. We would monitor your kidney function closely.

Correct answer: A

Rationale: The best response for the nurse to provide is that dialysis would need to be resumed if chronic rejection becomes a reality. Chronic rejection of a transplanted kidney can lead to kidney failure, necessitating the need for dialysis until another transplant is possible. Choice B is incorrect because although immunosuppressive therapy may be adjusted, the immediate concern is the potential need for dialysis. Choice C is incorrect because scheduling a second transplant immediately is not typically the first step following chronic rejection. Choice D is also incorrect as close monitoring of kidney function is essential but does not address the immediate need for dialysis if chronic rejection occurs.

2. A 75-year-old female client is admitted to the orthopedic unit following an open reduction and internal fixation of a hip fracture. On the second postoperative day, the client becomes confused and repeatedly asks the nurse where she is. What information is most important for the nurse to obtain?

• A. History of alcohol use
• B. Current medication list
• C. Baseline cognitive status
• D. Family history of dementia

Correct answer: A

Rationale: The correct answer is A: History of alcohol use. In this scenario, obtaining the history of alcohol use is crucial as it could indicate withdrawal, which might explain the client's confusion. Alcohol withdrawal can lead to symptoms such as confusion, agitation, and disorientation. While knowing the current medication list (choice B) is important for overall patient care, in this case, alcohol withdrawal is a more likely cause of the confusion. Baseline cognitive status (choice C) is valuable for comparison but may not directly explain the sudden confusion. Family history of dementia (choice D) is less relevant in this acute situation compared to the potential immediate impact of alcohol withdrawal.

3. The nurse reviews the laboratory findings of a client with an open fracture of the tibia. The white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) are elevated. Before reporting this information to the healthcare provider, what assessment should the nurse obtain?

• A. Appearance of wound
• B. Pain level
• C. Presence of fever
• D. Mobility status

Correct answer: A

Rationale: The correct answer is A: Appearance of wound. Elevated WBC and ESR levels suggest a possible infection in the client with an open fracture. Assessing the wound's appearance is crucial to evaluate for signs of infection, such as redness, warmth, swelling, or drainage. By assessing the wound first, the nurse can provide important information to the healthcare provider regarding the potential infection, which may require immediate intervention. Choices B, C, and D are important assessments in caring for a client with an open fracture; however, in this scenario, the priority is to assess the wound for signs of infection due to the elevated WBC and ESR levels.

4. A male client with impaired renal function who takes ibuprofen daily for chronic arthritis is admitted with gastrointestinal (GI) bleeding. After administering IV fluids and a blood transfusion, his blood pressure is 100/70, and his renal output is 20 ml/hour. Which intervention should the nurse include in care?

• A. Maintain the client NPO during the diuresis phase.
• B. Evaluate daily serial renal laboratory studies for progressive elevations.
• C. Observe the urine character for sedimentation and cloudy appearance.
• D. Monitor for onset of polyuria greater than 150ml/hour.

Correct answer: B

Rationale: Evaluating daily renal laboratory studies is crucial in this scenario. The client has impaired renal function, recent GI bleeding, and is at risk for further kidney damage due to ibuprofen use. Monitoring renal labs helps assess kidney function and detect any progressive elevations, guiding further interventions. Option A is not directly related to renal function monitoring. Option C focuses more on urine appearance than renal function assessment. Option D mentions polyuria, which is excessive urine output, but the question describes a client with reduced renal output.

5. The nurse observes an unlicensed assistive personnel (UAP) positioning a newly admitted client who has a seizure disorder. The client is supine, and the UAP is placing soft pillows along the side rails. What action should the nurse take?

• A. Ensure that the UAP has positioned the pillows effectively to protect the client.
• B. Instruct the UAP to obtain soft blankets to secure to the side rails instead of pillows.
• C. Assume responsibility for placing the pillows while the UAP completes another task.
• D. Ask the UAP to use some of the pillows to prop the client in a side-lying position.

Correct answer: B

Rationale: The nurse should instruct the UAP to pad the side rails with soft blankets instead of pillows. Placing pillows along the side rails could lead to suffocation during a seizure and would need to be removed promptly. Instructing the UAP to use soft blankets is safer as they can help prevent injury without posing a risk of suffocation. Ensuring effective placement of the pillows (Choice A) is not appropriate as pillows should not be used in this situation. Assuming responsibility for placing the pillows (Choice C) or propping the client in a side-lying position with pillows (Choice D) are both unsafe actions and could potentially harm the client.

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