Nursing Elites

1. To help minimize the risk of postoperative respiratory complications after a hypophysectomy, during preoperative teaching, the nurse should instruct the client how to:

• A. Use incentive spirometry.
• B. Turn in bed.
• C. Take deep breaths.
• D. Cough.

Correct answer: C

Rationale: The correct answer is to instruct the client on how to take deep breaths. Deep breathing exercises are essential in preventing postoperative respiratory complications like atelectasis by promoting lung expansion. Using incentive spirometry is a more specific and advanced method of promoting deep breathing and lung expansion, making it a better choice than just turning in bed. While turning in bed may help with overall comfort and positioning, it is not as directly related to respiratory complications as deep breathing exercises. Coughing, although important for clearing secretions, is not as effective in preventing atelectasis as deep breathing exercises.

2. A client with renal insufficiency and a low red blood cell count asks, 'Is my anemia related to the renal insufficiency?' How should the nurse respond?

• A. Red blood cells produce erythropoietin, which increases blood flow to the kidneys.
• B. Your anemia and renal insufficiency are related to inadequate vitamin D and a loss of bone density.
• C. Erythropoietin is usually released from the kidneys and stimulates red blood cell production in the bone marrow.
• D. Kidney insufficiency inhibits active transportation of red blood cells throughout the blood.

Correct answer: C

Rationale: The correct answer is C. Erythropoietin is produced in the kidney and is released in response to decreased oxygen tension in the renal blood supply. Erythropoietin stimulates red blood cell production in the bone marrow. Anemia in renal insufficiency is often due to decreased erythropoietin production. Anemia and renal insufficiency are not manifestations of vitamin D deficiency as stated in choice B. Choice A is incorrect as erythropoietin does not increase blood flow to the kidneys. Choice D is incorrect because kidney insufficiency does not inhibit active transportation of red blood cells throughout the blood; rather, it affects erythropoietin production and subsequent red blood cell formation.

3. A client has had a pulmonary artery catheter inserted. In performing hemodynamic monitoring with the catheter, the nurse will wedge the catheter to gain information about which of the following?

• A. Cardiac output.
• B. Right atrial blood flow.
• C. Left end-diastolic pressure.
• D. Cardiac index.

Correct answer: C

Rationale: The correct answer is C: Left end-diastolic pressure. Wedging the pulmonary artery catheter allows the nurse to obtain the pulmonary artery wedge pressure, which reflects the left end-diastolic pressure. This pressure is essential in assessing left ventricular function and diagnosing conditions like heart failure. Choices A, B, and D are incorrect because wedging the catheter does not directly provide information about cardiac output, right atrial blood flow, or cardiac index.

4. A healthcare professional assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of bacterial cystitis?

• A. A 36-year-old female who has never been pregnant
• B. A 42-year-old male who is prescribed cyclophosphamide
• C. A 58-year-old female who is not taking estrogen replacement
• D. A 77-year-old male with mild congestive heart failure

Correct answer: C

Rationale: Females are at higher risk of developing bacterial cystitis due to their shorter urethra compared to males. Postmenopausal women not on estrogen replacement therapy are particularly susceptible to cystitis because of changes in vaginal and urethral cells. This increases the risk of bacterial infection. The other options do not have the same level of risk as the postmenopausal woman not using hormone replacement therapy. A never-pregnant middle-aged woman does not have the same increased risk as a postmenopausal woman with hormonal changes.

5. Which of the following interventions is most appropriate for a patient with left-sided heart failure?

• A. Administering IV fluids.
• B. Administering oxygen.
• C. Administering diuretics.
• D. Administering antihypertensives.

Correct answer: B

Rationale: Administering oxygen is the most appropriate intervention for a patient with left-sided heart failure because it helps improve oxygenation. In left-sided heart failure, the heart struggles to pump oxygen-rich blood to the body, leading to inadequate oxygen supply to tissues. Administering oxygen can help alleviate symptoms of hypoxia and reduce the workload on the heart. IV fluids (Choice A) may exacerbate heart failure by increasing fluid volume, diuretics (Choice C) are used to reduce fluid overload in heart failure, and antihypertensives (Choice D) are more suitable for managing hypertension, which may be a comorbidity in heart failure but are not the primary intervention for left-sided heart failure.

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