Nursing Elites

1. One of the major functions of the kidneys in maintaining normal fluid balance is:

• A. the manufacture of antidiuretic hormone.
• B. the regulation of calcium and phosphate balance.
• C. the regulation of the pH of the extracellular fluid.
• D. the control of aldosterone levels.

Correct answer: C

Rationale: The correct answer is 'the regulation of the pH of the extracellular fluid.' The kidneys play a crucial role in maintaining normal fluid balance by regulating extracellular fluid and osmolarity through selective retention and excretion of fluids. Additionally, they regulate the pH of the extracellular fluid by retaining hydrogen ions and excreting metabolic wastes and toxic substances. Choice A is incorrect because antidiuretic hormone (ADH) is manufactured by the pituitary gland, not the kidneys. Choice B is incorrect as the regulation of calcium and phosphate balance is primarily controlled by the parathyroid gland. Choice D is incorrect as aldosterone levels are controlled by the adrenal glands, not the kidneys.

2. A nurse reviews the health history of a client who will be seeing the health care provider to obtain a prescription for a combination oral contraceptive (estrogen and progestin). Which finding in the health history would cause the nurse to determine that the use of a combination oral contraceptive is contraindicated?

• A. The client has type 2 diabetes mellitus.
• B. The client is being treated for hypertension.
• C. The client has been treated for breast cancer.
• D. The client has hyperlipidemia.

Correct answer: C

Rationale: The correct answer is that the client has been treated for breast cancer. Combination oral contraceptives containing estrogen and progestin are contraindicated for women with a history of certain conditions, such as thrombophlebitis, thromboembolic disorders, cerebrovascular disease, coronary artery disease, myocardial infarction, known or suspected breast cancer, known or suspected estrogen-dependent neoplasm, benign or malignant liver tumors, and undiagnosed abnormal genital bleeding. Although having type 2 diabetes mellitus, being treated for hypertension, or having hyperlipidemia are risk factors that require caution when using combination oral contraceptives, they are not absolute contraindications like a history of breast cancer.

3. A nurse is covering a pediatric unit and is responsible for a 15-year-old male patient on the floor. The mother of the child states, "I think my son is sexually interested in girls."? The most appropriate course of action for the nurse is to respond by stating:

• A. "I will talk to the doctor about it."?
• B. "Has this been going on for a while?"?
• C. "How do you know this?"?
• D. "Teenagers often exhibit signs of sexual interest in females."?

Correct answer: D

Rationale: The most appropriate response for the nurse in this situation is to acknowledge that teenagers often exhibit signs of sexual interest in females. This response normalizes the mother's concern and provides reassurance that such behavior is typical during adolescence. Option A deflects the conversation to the doctor without addressing the mother's concern directly. Option B focuses on the duration rather than addressing the mother's statement. Option C may come off as defensive or dismissive, questioning the mother's observation. Therefore, the best response is to acknowledge the normalcy of teenage behavior regarding sexual interest.

4. A client complaining of chest pain is prescribed an intravenous infusion of nitroglycerin (Nitro-Bid). After the infusion is initiated, the occurrence of which symptom warrants the nurse discontinuing an intravenous infusion of nitroglycerin?

• A. Frontal headache
• B. Orthostatic hypotension
• C. Decrease in intensity of chest pain
• D. Cool clammy skin

Correct answer: D

Rationale: The correct answer is 'Cool clammy skin.' This assessment finding indicates decreased cardiac output that could result from excessive vasodilation. Cool clammy skin is a sign of poor perfusion, suggesting that the blood pressure might be dropping too low. Discontinuing the nitroglycerin infusion is crucial to prevent further complications. Choice A, 'Frontal headache,' is a common side effect of nitroglycerin but not a reason to discontinue the infusion unless severe or persistent. Choice B, 'Orthostatic hypotension,' may occur as a side effect of nitroglycerin but does not necessarily warrant discontinuation unless severe. Choice C, 'Decrease in intensity of chest pain,' is actually an expected therapeutic response to nitroglycerin and indicates improved myocardial perfusion, so it is not a reason to stop the infusion.

5. When teaching bleeding precautions to a client with leukemia, the PN should include which of the following instructions?

• A. Use a soft toothbrush.
• B. Use dental floss daily.
• C. Hold pressure on any scrapes for 1-2 minutes.
• D. Use a triple-edged razor.

Correct answer: A

Rationale: The correct answer is to 'Use a soft toothbrush.' A soft toothbrush is recommended because it is less likely to cause the gums to bleed in clients with leukemia, who are at risk of bleeding due to overcrowding of white cells at the expense of other cell types like platelets. Choice B, 'Use dental floss daily,' is incorrect because dental floss is contraindicated and can make the gums bleed in clients with leukemia. Choice C, 'Hold pressure on any scrapes for 1-2 minutes,' is incorrect because when clotting is impaired, pressure should be held for 5-10 minutes or longer until the bleeding stops. Choice D, 'Use a triple-edged razor,' is incorrect because an electric razor should be used instead of a triple-edged razor to prevent small cuts and bleeding in clients with leukemia.

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