Nursing Elites

1. The healthcare provider is assessing a client with chronic renal failure who is receiving hemodialysis. Which of the following findings would indicate that the client is experiencing a complication of the treatment?

• A. Clear dialysate outflow.
• B. Blood pressure of 150/90 mm Hg.
• C. Increased heart rate.
• D. Fatigue.

Correct answer: B

Rationale: A blood pressure of 150/90 mm Hg during hemodialysis may indicate fluid overload or an ineffective dialysis session, which can lead to complications such as heart failure or pulmonary edema. This finding should be reported promptly for further evaluation and intervention. Clear dialysate outflow is a normal and expected finding during hemodialysis, indicating proper filtration of waste products. Increased heart rate can be a normal compensatory response to hemodialysis due to fluid shifts and should be monitored but does not necessarily indicate a complication. Fatigue is a common symptom in clients with chronic renal failure undergoing hemodialysis and is not specific to complications of the treatment.

2. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse’s priority action?

• A. Calculate the mean arterial pressure (MAP).
• B. Ask for insertion of a pulmonary artery catheter.
• C. Take the client’s pulse.
• D. Slow down the normal saline infusion.

Correct answer: D

Rationale: The nurse should recognize that the client may be developing fluid overload and respiratory distress due to the rapid normal saline infusion. The priority action is to slow down the infusion to prevent worsening respiratory distress and potential fluid overload. While calculating the mean arterial pressure (MAP) is important to assess perfusion, addressing the immediate respiratory distress takes precedence. Inserting a pulmonary artery catheter would provide detailed hemodynamic information but is not the initial step in managing acute respiratory distress. Monitoring vital signs, including the client's pulse, is crucial after adjusting the intravenous infusion to ensure a safe response to the intervention.

3. A client who is scheduled for cardiac catheterization to rule out coronary occlusion should be informed by the nurse that:

• A. The procedure is performed in a darkened room in the radiology department
• B. It is necessary to lie quietly on a hard x-ray table for about 4 hours
• C. The room is bright and well lit, and it is best to keep the eyes closed
• D. The client may have feelings of warmth or flushing during the procedure

Correct answer: D

Rationale: Before cardiac catheterization, the nurse should inform the client that the procedure is performed in a darkened room in the radiology department, not the operating room. The client should expect to lie still on an x-ray table for the duration of the procedure, not necessarily for about 4 hours. Keeping the eyes closed is not necessary as the room is usually dimly lit. The client may experience sensations of warmth or flushing during the procedure due to catheter passage and dye injection, making choice D the correct answer.

4. During a routine clinic visit, a nurse is assessing a 48-year-old client with a history of smoking. The client, who exercises regularly, reports calf pain during exercise that disappears at rest. Which of the following findings requires further evaluation?

• A. Heart rate of 57 bpm.
• B. SpO2 of 94% on room air.
• C. Blood pressure of 134/82.
• D. Ankle-brachial index of 0.65.

Correct answer: D

Rationale: An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client experiencing intermittent claudication, indicating compromised blood flow to the lower extremities during exercise. This finding requires further evaluation to assess the severity of arterial insufficiency and determine appropriate interventions. Choice A (Heart rate of 57 bpm) is within the normal range for an adult at rest and indicates good cardiovascular fitness. Choice B (SpO2 of 94% on room air) is slightly lower than the normal range but is generally acceptable in a healthy individual. Choice C (Blood pressure of 134/82) falls within the normal range and does not raise immediate concerns in this context.

5. A middle-aged female client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year. The client asks, 'What can I do to help prevent these infections?' How should the nurse respond?

• A. Test your urine daily for the presence of ketone bodies and proteins.
• B. Use tampons rather than sanitary napkins during your menstrual period.
• C. Drink more water and empty your bladder more frequently during the day.
• D. Keep your hemoglobin A1c under 9% by controlling your blood sugar levels.

Correct answer: C

Rationale: The correct answer is C. Clients with long-standing diabetes mellitus are at risk for pyelonephritis due to various reasons. Elevated blood glucose levels in diabetes can lead to glucose spilling into the urine, altering the pH and creating a conducive environment for bacterial growth. Neuropathy associated with diabetes can reduce bladder tone and diminish the sensation of bladder fullness, resulting in less frequent voiding and increased risk of stasis and bacterial overgrowth. Increasing fluid intake, particularly water, and voiding regularly can help prevent stasis and microbial overgrowth. Testing urine for ketones and proteins or using tampons instead of sanitary napkins are not effective strategies for preventing pyelonephritis. Keeping the hemoglobin A1c levels below 9% is crucial for managing diabetes, but it alone does not directly prevent pyelonephritis.

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