Nursing Elites

1. The client with chronic renal failure is on a fluid restriction. Which of the following statements by the client indicates that the teaching has been effective?

• A. I will limit my fluid intake to prevent fluid overload.
• B. I can drink as much fluid as I want as long as I take my medication.
• C. I will skip dialysis sessions if I feel tired.
• D. I will limit my fluid intake to 1 liter per day.

Correct answer: A

Rationale: Choice A is the correct answer because it demonstrates the client's understanding of the need to limit fluid intake to prevent fluid overload, which is crucial in managing chronic renal failure. Adequate fluid restriction is essential to prevent complications such as fluid overload and electrolyte imbalances. Choice B is incorrect as it promotes excessive fluid intake, which can worsen the client's condition by putting additional stress on the kidneys. Choice C is incorrect as skipping dialysis sessions can lead to a buildup of toxins in the body, worsening renal failure and potentially leading to life-threatening complications. Choice D is incorrect because limiting fluid intake to a specific volume may not be appropriate for all clients and can vary depending on individual needs, medical condition, and healthcare provider recommendations.

2. The nurse is administering intravenous fluids to a dehydrated patient. On the second day of care, the patient's weight has increased by 2.25 pounds. The nurse would expect that the patient's fluid intake has

• A. equaled urine output.
• B. exceeded urine output by 1 L.
• C. exceeded urine output by 2.5 L.
• D. exceeded urine output by 3 L.

Correct answer: B

Rationale: A weight gain of 1 kg, or approximately 2.2 to 2.5 lb, is generally equivalent to 1 liter (L) of fluid retained by the body. In this case, the patient's weight gain of 2.25 pounds suggests an excess fluid retention of approximately 1 liter, indicating that the patient's fluid intake has exceeded urine output by 1 liter. Choices C and D are incorrect as they overestimate the fluid excess based on the patient's weight gain. Choice A is incorrect as it implies an exact balance between fluid intake and urine output, which is not reflected in the given weight increase.

3. A patient’s serum osmolality is 305 mOsm/kg. Which term describes this patient’s body fluid osmolality?

• A. Iso-osmolar
• B. Hypo-osmolar
• C. Hyperosmolar
• D. Isotonic

Correct answer: C

Rationale: The correct term to describe a patient with a serum osmolality of 305 mOsm/kg is 'hyperosmolar.' Normal osmolality ranges from 280 to 300 mOsm/kg. A patient with an osmolality above this range is considered hyperosmolar. Choice A ('Iso-osmolar') implies an equal osmolality, which is not the case in this scenario. Choice B ('Hypo-osmolar') suggests a lower osmolality, which is incorrect based on the provided serum osmolality value. Choice D ('Isotonic') refers to a solution having the same osmolality as another solution, not describing the specific scenario of this patient being above the normal range.

4. A nurse teaches clients about the difference between urge incontinence and stress incontinence. Which statements should the nurse include in this education? (Select all that apply.)

• A. Urge incontinence involves a post-void residual volume less than 50 mL.
• B. Stress incontinence occurs due to weak pelvic floor muscles.
• C. Stress incontinence usually occurs in people with dementia.
• D. Urge incontinence can be managed by increasing fluid intake.

Correct answer: B

Rationale: The correct statement to include in the education about urge incontinence and stress incontinence is choice B. Stress incontinence occurs due to weak pelvic floor muscles or urethral sphincter, leading to the inability to tighten the urethra sufficiently to overcome increased detrusor pressure. This condition is common after childbirth when pelvic muscles are stretched and weakened. Urge incontinence, on the other hand, is characterized by the inability to suppress the contraction signal from the detrusor muscle. It is often associated with abnormal detrusor contractions, which can be due to neurological abnormalities rather than post-void residual volume. Choice A is incorrect because urge incontinence is not defined by post-void residual volume. Choice C is incorrect as stress incontinence is not usually linked to dementia. Choice D is incorrect because increasing fluid intake is not a management strategy for urge incontinence.

5. After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I will take a laxative every night before going to bed.
• B. I must increase my intake of dietary fiber and fluids.
• C. I shall only use salt when I am cooking my own food.
• D. I’ll eat white bread to minimize gastrointestinal gas.

Correct answer: B

Rationale: Choice B is the correct answer. Clients with PKD often experience constipation, which can be managed by increasing their intake of dietary fiber and fluids. This helps promote bowel regularity. Laxatives should be used cautiously and not as a routine solution. Choice A is incorrect as regular laxative use is not recommended. Choice C is incorrect as a low-salt diet is typically advised for clients with PKD, not just limiting salt while cooking. Choice D is incorrect as white bread is low in fiber and not beneficial for managing constipation, which is common in PKD.

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