Nursing Elites

1. The client has been receiving peritoneal dialysis. The nurse should assess the client for which of the following complications that is most likely to occur?

• A. Electrolyte imbalance
• B. Peritonitis
• C. Infection
• D. Hyperglycemia

Correct answer: B

Rationale: Peritonitis is the most likely complication to occur in clients receiving peritoneal dialysis due to the risk of infection. Peritonitis is a serious inflammation of the peritoneum lining the abdominal cavity, commonly caused by infection. While electrolyte imbalance and hyperglycemia are possible complications in some cases, peritonitis poses a more immediate and severe threat to the client's health. Infection is a general term that can encompass peritonitis but is not as specific as directly identifying peritonitis as the primary concern in this scenario.

2. An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that his tongue is somewhat cracked, and his eyeballs are sunken into his head. What nursing intervention is indicated?

• A. Help the client determine ways to increase his fluid intake.
• B. Obtain an appointment for the client to see a pulmonologist.
• C. Schedule an appointment with a nutritionist to assess the client's diet.
• D. Encourage the client to slightly increase his use of oxygen at night and to always use humidified oxygen.

Correct answer: A

Rationale: The correct nursing intervention in this scenario is to assist the client in finding ways to increase his fluid intake. Clients with COPD, including emphysema, should aim to consume at least three liters of fluids per day to help keep their mucus thin. As the disease progresses, these clients may decrease fluid intake due to various reasons. Suggesting creative methods, such as having disposable fruit juices readily available, can help the client meet this goal. Option B is incorrect as seeing an ear, nose, and throat specialist is not directly related to the client's symptoms. Option C is not the priority in this case, as the main concern is addressing the client's dehydration. Option D does not address the immediate need for managing the client's dehydration and is not the most appropriate intervention at this time.

3. A client with type 1 diabetes mellitus has a blood glucose level of 620 mg/dL. After the nurse calls the physician to report the finding and monitors the client closely for:

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: In the scenario described, a client with a blood glucose level of 620 mg/dL and type 1 diabetes mellitus is at risk of developing metabolic acidosis. In type 1 diabetes, the lack of sufficient circulating insulin leads to an increase in blood glucose levels. As the body cells utilize all available glucose, the breakdown of fats for energy results in the production of ketones, leading to metabolic acidosis. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis are not typically associated with uncontrolled type 1 diabetes. Metabolic alkalosis is more commonly linked to conditions such as vomiting or excessive diuretic use, while respiratory acidosis and respiratory alkalosis are related to respiratory system imbalances in carbon dioxide levels.

4. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?” How should the nurse respond?

• A. Your immune system becomes less effective as you age.
• B. Low estrogen levels can make the tissue more susceptible to infection.
• C. You should be more careful with your personal hygiene in this area.
• D. It is likely that you have an untreated sexually transmitted disease.

Correct answer: B

Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.

5. A nurse cares for adult clients who experience urge incontinence. For which client should the nurse plan a habit training program?

• A. A 78-year-old female who is confused
• B. A 65-year-old male with diabetes mellitus
• C. A 52-year-old female with kidney failure
• D. A 47-year-old male with arthritis

Correct answer: A

Rationale: For a bladder training program to succeed in a client with urge incontinence, the client must be alert, aware, and able to resist the urge to urinate. Habit training will work best for a confused client. This includes going to the bathroom (or being assisted to the bathroom) at set times. The other clients may benefit from other types of bladder training. A confused client may need structured assistance to establish a regular bathroom routine, which can help manage urge incontinence effectively. Clients with diabetes mellitus, kidney failure, or arthritis may require different strategies tailored to their specific conditions.

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