Nursing Elites

1. The PN is caring for a client with diabetes insipidus. The nurse can expect the lab work to show:

• A. elevated urine osmolarity and elevated serum osmolarity.
• B. decreased urine osmolarity and decreased serum osmolarity.
• C. elevated urine osmolarity and decreased serum osmolarity.
• D. decreased urine osmolarity and elevated serum osmolarity.

Correct answer: D

Rationale: In diabetes insipidus, the pituitary releases too much antidiuretic hormone (ADH), causing the client to produce a large amount of dilute urine (decreased osmolarity) and leading to dehydration (elevated serum osmolarity). Therefore, the correct answer is decreased urine osmolarity and elevated serum osmolarity. Choice C, elevated urine osmolarity and decreased serum osmolarity, is incorrect for diabetes insipidus, as it is more characteristic of syndrome of inappropriate ADH (SIADH). Choices A and B, elevated urine osmolarity and elevated serum osmolarity, and decreased urine osmolarity and decreased serum osmolarity, respectively, are generally not seen in diabetes insipidus, as urine and serum osmolarity typically move in opposite directions in this condition.

2. What is the most common cause of acute renal failure?

• A. Shock
• B. Nephrotoxic drugs
• C. Enlarged prostate
• D. Diabetes

Correct answer: A

Rationale: The correct answer is 'Shock.' Acute renal failure is commonly caused by inadequate blood flow to the kidneys, which can occur in cases of shock. This leads to decreased kidney function and potential kidney damage. While nephrotoxic drugs can also cause acute renal failure, shock is the primary and most common cause. An enlarged prostate may lead to obstructive uropathy but is not the most prevalent cause of acute renal failure. Diabetes is typically associated with chronic kidney disease rather than acute renal failure.

3. The nurse is preparing for a dressing change on a full thickness burn to the flank area. The orders include irrigating the wound with each dressing change. To irrigate the wound, what will the nurse use?

• A. Sterile saline
• B. Distilled water
• C. Betadine scrub
• D. Tap water

Correct answer: A

Rationale: When irrigating a wound, especially in the case of a full-thickness burn, it is crucial to use a solution that is gentle and non-irritating to the tissues. Sterile saline is the preferred choice for wound irrigation as it is isotonic and does not cause additional damage to the already compromised tissue. Distilled water lacks the electrolytes present in saline, Betadine scrub is not used for irrigation due to its potential to be cytotoxic, and tap water may introduce contaminants and microorganisms to the wound.

4. A 70-year-old male who is recovering from a stroke exhibits signs of unilateral neglect. Which behavior is suggestive of unilateral neglect?

• A. The client is observed shaving only one side of his face.
• B. The client is unable to distinguish between two tactile stimuli presented simultaneously.
• C. The client is unable to complete a range of vision without turning his head side to side.
• D. The client is unable to carry out cognitive and motor activity at the same time.

Correct answer: A

Rationale: Unilateral neglect is a condition where a person ignores one side of their body. In this case, the behavior of shaving only one side of the face indicates neglect of the other side. This behavior is suggestive of unilateral neglect as the individual is failing to attend to one side of their body. Choices B, C, and D are not associated with unilateral neglect. Choice B refers to tactile agnosia, a condition where a person cannot recognize objects by touch, not related to ignoring one side of the body. Choice C describes a visual field cut, which is a different visual deficit. Choice D relates to dual-task interference, not specific to ignoring one side of the body.

5. The client develops a tension pneumothorax. Assessment is expected to reveal?

• A. Sudden hypertension and bradycardia
• B. Productive cough with yellow mucus
• C. Tracheal deviation and dyspnea
• D. Sudden development of profuse hemoptysis and weakness

Correct answer: C

Rationale: In a tension pneumothorax, the trachea deviates to the unaffected side due to increased pressure in the affected pleural space, causing respiratory distress. Dyspnea is a hallmark symptom as the lung on the affected side collapses, leading to difficulty in breathing. Sudden hypertension and bradycardia (Choice A) are not typical findings of tension pneumothorax. Productive cough with yellow mucus (Choice B) is more suggestive of respiratory infections rather than a tension pneumothorax. Sudden development of profuse hemoptysis and weakness (Choice D) is not characteristic of tension pneumothorax presentation.

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