Nursing Elites

1. The nurse is caring for a client with laryngeal cancer. Which finding ascertained in the health history would not be common for this diagnosis?

• A. Foul breath
• B. Dysphagia
• C. Diarrhea
• D. Chronic hiccups

Correct answer: Diarrhea

Rationale: Diarrhea is not a common finding in clients with laryngeal cancer. Foul breath (A), dysphagia (B), and chronic hiccups (D) are expected findings associated with laryngeal cancer. Foul breath can result from tissue breakdown in the mouth and throat. Dysphagia, or difficulty swallowing, can occur due to the tumor's location affecting the swallowing mechanism. Chronic hiccups can be a symptom of irritation to the phrenic nerves from the cancer.

2. The client is admitted to the unit after a cholecystectomy. Montgomery straps are utilized with this client. The nurse is aware that Montgomery straps are utilized on this client because:

• A. The client is at risk for evisceration.
• B. The client will require frequent dressing changes.
• C. The straps provide support for drains that are inserted in the incision.
• D. No sutures or clips are used to secure the incision.

Correct answer: The client will require frequent dressing changes.

Rationale: Montgomery straps are used to secure dressings that require frequent changes due to the large amount of drainage usually present after a cholecystectomy. They are also beneficial for clients allergic to various types of tape. Answer A is incorrect as the client is not at higher risk of evisceration. Answer C is incorrect because Montgomery straps are not used to support drains. Answer D is incorrect as sutures or clips are typically used to secure the incision after gallbladder surgery, not Montgomery straps.

3. Which of the following clients should refrain from therapy with the thiazide diuretic hydrochlorothiazide?

• A. a client with renal impairment
• B. a client with hypertension
• C. a client with diabetes mellitus, type II
• D. a client with renal calculi (kidney stones)

Correct answer: a client with diabetes mellitus, type II

Rationale: The correct answer is a client with diabetes mellitus, type II. Thiazide diuretics like hydrochlorothiazide can cause metabolic abnormalities, including elevated blood glucose levels. This increase is linked to diuretic-induced potassium deficiency, which reduces insulin secretion, leading to higher plasma glucose levels. Thiazides are commonly used in clients with renal impairment and hypertension. Moreover, thiazides decrease calcium excretion, reducing the risk of renal calculi, so it is not contraindicated for clients with kidney stones. Therefore, clients with diabetes mellitus, type II should avoid therapy with hydrochlorothiazide due to the potential adverse effects on blood glucose levels.

4. Why might the physician order antibiotics to be given through the central venous access device (CVAD) rather than through a peripheral IV line if the CVAD becomes infected?

• A. To prevent infiltration of the peripheral line
• B. To reduce the pain and discomfort associated with antibiotic administration in a small vein
• C. To lessen the chance of an allergic reaction to the antibiotic
• D. To attempt to eliminate microorganisms in the catheter and prevent having to remove it

Correct answer: To attempt to eliminate microorganisms in the catheter and prevent having to remove it

Rationale: When a patient's central venous access device (CVAD) becomes infected, administering antibiotics through the line is essential to attempt to eliminate microorganisms within the catheter. The goal is to prevent the necessity of removing the catheter, which might be required if the infection persists. Choice A, 'To prevent infiltration of the peripheral line,' is incorrect as the priority is addressing the catheter infection, not preventing issues with a peripheral line. Choice B, 'To reduce the pain and discomfort associated with antibiotic administration in a small vein,' is not relevant to the rationale for choosing the CVAD for antibiotic administration. Choice C, 'To lessen the chance of an allergic reaction to the antibiotic,' is also incorrect as the main focus is managing the catheter-associated infection rather than allergy prevention.

5. A client with cancer is to undergo an intravenous pyelogram. The nurse should:

• A. Ensure adequate fluid intake 24 hours before the procedure
• B. Ask the client to void immediately before the study
• C. Administer medication that affects the central nervous system as prescribed
• D. Position the client appropriately for the procedure

Correct answer: B: Ask the client to void immediately before the study

Rationale: The correct answer is to ask the client to void immediately before the study. For an intravenous pyelogram, the client may have orders for laxatives or enemas, so ensuring the client voids before the test is important to prevent obscuring visualization of the kidney, ureters, and bladder. Choice A is incorrect because there is no need to force fluids before the procedure. Choice C is incorrect as medications affecting the central nervous system should not be held unless specified by the healthcare provider. Choice D is incorrect as covering the reproductive organs with an x-ray shield is not necessary for an intravenous pyelogram.

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