Nursing Elites

1. Following the diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. Which of the following measures would most likely help the client prevent this problem?

• A. Climb the stairs early in the day.
• B. Rest for at least an hour before climbing the stairs.
• C. Take a nitroglycerin tablet before climbing the stairs.
• D. Lie down after climbing the stairs.

Correct answer: C

Rationale: The correct answer is to take a nitroglycerin tablet before climbing the stairs. Nitroglycerin helps prevent angina by dilating the coronary arteries, which increases blood flow to the heart. This medication can help reduce the chest pain and discomfort experienced during physical exertion. Climing the stairs early in the day (Choice A) does not address the underlying issue of inadequate blood flow to the heart. Resting for at least an hour before climbing the stairs (Choice B) may not be as effective in preventing angina as taking nitroglycerin. Lying down after climbing the stairs (Choice D) does not offer a preventive measure for angina; it is more focused on post-activity rest rather than prevention.

2. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?

• A. Albumin level of 2.5 g/dL
• B. Phosphorus level of 5 mg/dL
• C. Sodium level of 135 mmol/L
• D. Potassium level of 5.5 mmol/L

Correct answer: A

Rationale: In chronic renal failure, a protein-restricted diet is crucial to prevent the buildup of waste products. A low albumin level (<3.5 g/dL) indicates inadequate protein intake, raising concern as it may lead to malnutrition and tissue breakdown. Phosphorus, sodium, and potassium levels are not directly impacted by protein intake. Phosphorus levels may elevate in renal failure, but at 5 mg/dL, it is within normal range. Sodium and potassium levels are also within normal limits and not influenced by protein restriction.

3. The client with chronic renal failure asks why a low-protein diet is necessary. Which of the following is the best response by the nurse?

• A. It reduces the workload on your kidneys.
• B. It helps prevent the buildup of waste products.
• C. It helps maintain electrolyte balance in your body.
• D. It helps prevent dehydration.

Correct answer: B

Rationale: A low-protein diet is necessary for clients with chronic renal failure to help prevent the buildup of waste products, such as urea, in the body. Choice A is incorrect as the primary reason for a low-protein diet is to manage waste product accumulation rather than reducing the workload on the kidneys. Choice C is incorrect as electrolyte balance is typically managed through dietary restrictions beyond protein intake. Choice D is incorrect as preventing dehydration is not the primary purpose of a low-protein diet in chronic renal failure.

4. A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

• A. Encourage the client to drink more fluids.
• B. Contact the provider and recommend a low-sodium diet.
• C. Prepare to administer an intravenous diuretic.
• D. Obtain a suction device and implement seizure precautions.

Correct answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

5. The healthcare provider is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information?

• A. A review in the Cochrane Library.
• B. A literature search in a database, such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL).
• C. An online nursing textbook.
• D. The policy and procedure manual at the healthcare agency.

Correct answer: A

Rationale: The Cochrane Library provides systematic reviews of primary research in healthcare, making it a reliable resource for evidence-based practice. Choice B, a literature search in a database like CINAHL, may also be useful but does not guarantee the same level of systematic review and reliability as the Cochrane Library. Choice C, an online nursing textbook, may offer information but might not provide the most current or evidence-based practices. Choice D, the policy and procedure manual at the healthcare agency, is unlikely to offer the comprehensive evidence-based information needed for developing standards of care.

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