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. Before a dressing change to his legs, which intervention is most important for the nurse to implement?

• A. Encourage the patient to stay at the bedside
• B. Use distraction techniques to reduce pain
• C. Maintain strict aseptic technique
• D. Place a drape over the burn area

Correct answer: C

Rationale: Maintaining strict aseptic technique is crucial before a dressing change for burn patients to prevent infection. Encouraging the patient to stay at the bedside, using distraction techniques, or placing a drape over the burn area are not as critical as ensuring asepsis in this situation.

3. When administering ceftriaxone sodium (Rocephin) intravenously to a client, what finding requires the most immediate intervention by the nurse?

• A. Stridor
• B. Nausea
• C. Headache
• D. Pruritus

Correct answer: A

Rationale: The correct answer is A: Stridor. Stridor is a high-pitched sound that indicates airway obstruction. When administering ceftriaxone sodium (Rocephin) intravenously, if the client develops stridor, it is a medical emergency requiring immediate intervention to maintain a patent airway. Nausea, headache, and pruritus are important to assess, but they do not pose an immediate threat to the client's airway and would not require the same level of urgent intervention as stridor.

4. An elderly female client with osteoarthritis reports increasing pain and stiffness in her right knee and asks how to reduce these symptoms. In responding to the client, the nurse recognizes what pathology as the cause of her symptoms?

• A. Destruction of joint cartilage.
• B. Inflammation of synovial membrane.
• C. Formation of bone spurs.
• D. Reduction of joint space.

Correct answer: A

Rationale: Corrected Rationale: Osteoarthritis typically involves the destruction of joint cartilage, leading to pain and stiffness. This destruction of joint cartilage results in bone rubbing against bone, causing pain and reduced mobility. Choices B, C, and D are incorrect. Inflammation of the synovial membrane (choice B) is more commonly associated with rheumatoid arthritis. Formation of bone spurs (choice C) and reduction of joint space (choice D) are manifestations that can occur as a result of osteoarthritis but are not the primary pathology responsible for the symptoms of pain and stiffness.

5. A female client is admitted with end-stage pulmonary disease, is alert, oriented, and complaining of shortness of breath. The client tells the nurse that she wants 'no heroic measures' taken if she stops breathing, and she asks the nurse to document this in her medical record. What action should the nurse implement?

• A. Ask the client to discuss 'do not resuscitate' with her healthcare provider
• B. Document the client's wishes in her medical record
• C. Ask the client to sign an advance directive
• D. Place a 'Do Not Resuscitate' (DNR) order in the client's chart

Correct answer: A

Rationale: The correct action for the nurse to implement is to ask the client to discuss 'do not resuscitate' (DNR) wishes with her healthcare provider. This is important to ensure that the client makes informed decisions regarding her care. While documenting the client's wishes in her medical record is essential, it is crucial that the client discusses these wishes with the healthcare provider to understand the implications and have the DNR order legally documented. Asking the client to sign an advance directive is premature without a detailed discussion with the healthcare provider. Placing a 'Do Not Resuscitate' (DNR) order in the client's chart should only be done after the client has discussed and agreed upon this decision with the healthcare provider.

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