Nursing Elites

1. The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)

• A. Man with prostate cancer
• B. Woman with blood clots in the urinary tract
• C. Client with ureterolithiasis
• D. All of the above

Correct answer: D

Rationale: Post-renal acute kidney injury (AKI) occurs due to urine flow obstruction, which can result from conditions such as prostate cancer, blood clots in the urinary tract, and ureterolithiasis (kidney stones). Severe burns would lead to pre-renal AKI by reducing blood flow to the kidneys. Lupus would cause intrarenal AKI by affecting the kidney tissue directly. Therefore, options A, B, and C are correct choices for clients at risk for post-renal AKI, making option D the correct answer.

2. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for bladder cancer?

• A. A 25-year-old female with a history of sexually transmitted diseases
• B. A 42-year-old male who has worked in a lumber yard for 10 years
• C. A 55-year-old female who has had numerous episodes of bacterial cystitis
• D. An 86-year-old male with a 50–pack-year cigarette smoking history

Correct answer: D

Rationale: The correct answer is D. The greatest risk factor for bladder cancer is a long history of tobacco use, which is reflected in an 86-year-old male with a 50–pack-year cigarette smoking history. Smoking is a well-established risk factor for developing bladder cancer. Choices A, B, and C are not directly linked to an increased risk of bladder cancer. While sexually transmitted diseases, certain occupational exposures, and recurrent urinary tract infections may pose other health risks, they are not specifically associated with an elevated risk of bladder cancer.

3. A healthcare professional is reviewing laboratory results for a client who is at risk for nephrotoxicity due to medications. Which of the following serum creatinine results does the healthcare professional document as normal?

• A. 0.2 mg/dL
• B. 1.0 mg/dL
• C. 2.8 mg/dL
• D. 3.9 mg/dL

Correct answer: B

Rationale: The normal serum creatinine level typically ranges from 0.6 to 1.3 mg/dL. A result of 1.0 mg/dL falls within this normal range. A serum creatinine level of 0.2 mg/dL is abnormally low and may indicate decreased muscle mass or malnutrition. On the other hand, results of 2.8 mg/dL and 3.9 mg/dL are elevated, signifying impaired kidney function and potential nephrotoxicity from medications.

4. After pericardiocentesis for cardiac tamponade, for which signs should the nurse assess the client to determine if tamponade is recurring?

• A. Decreasing pulse
• B. Rising blood pressure
• C. Distant muffled heart sounds
• D. Falling central venous pressure (CVP)

Correct answer: C

Rationale: After pericardiocentesis for cardiac tamponade, the nurse should assess for distant muffled heart sounds that were noted before the procedure. If these sounds return, it could indicate recurring pericardial effusion and potential tamponade. Therefore, the correct answer is the return of distant muffled heart sounds (Option C). Decreasing pulse (Option A) and falling central venous pressure (Option D) are not specific signs of recurring tamponade. Rising blood pressure (Option B) is also not a typical sign of tamponade recurrence; in fact, hypotension is more commonly associated with tamponade.

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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