Adult Health Clinical Nurse Specialist Exam Prep Test

The client with chronic renal failure (CRF) needs to follow a low-protein and low-sodium diet to manage their condition. Option A, which includes a grilled chicken breast (a lean source of protein), broccoli (a low-sodium vegetable), and unsweetened tea (low in sodium), indicates that the client understands and is following their dietary restrictions. Option B includes high-sodium foods like ham, sour cream, and steak, as well as beer, which is also high in sodium. Option C includes a cheeseburger and french fries, which are both high in sodium, and saccharin sweet Kool Aid, which is not recommended for clients with CRF. Option D includes roast beef (high in protein and sodium), potato chips (high in sodium), and a soft drink (high in sodium).

A urine culture is the most diagnostic laboratory report for a urinary tract infection (UTI). This test involves growing bacteria from a urine sample in a laboratory setting to identify the specific bacteria causing the infection. This helps determine the most effective antibiotic treatment for the UTI. Hemogram is a complete blood count test that measures different components of blood and is not specific to UTIs. Urinalysis is a test that examines the physical, chemical, and microscopic properties of urine, but it may not always confirm the presence of a UTI. Metanephrines are substances that are tested to diagnose certain adrenal gland tumors and are not related to UTIs.

The nurse should provide the information about the client's intake and output in the last 24 hours to the healthcare provider. This information is important as it gives an overall picture of the client's urinary elimination and fluid balance. It helps the healthcare provider assess the client's hydration status and determine if any interventions are needed.

The client's symptoms of burning on urination, urgency to void, and a low-grade fever suggest a urinary tract infection (UTI). The first intervention should be to obtain a clean voided midstream urine sample for culture to confirm the presence of a UTI and identify the causative organism. This will guide appropriate antibiotic therapy. Initiating antibiotic treatment without confirming the diagnosis through urine culture may lead to unnecessary antibiotic use and potential antibiotic resistance. Inserting an IV catheter and starting fluids, arranging for admission, and initiating IV antibiotics can be done after the urine culture results are obtained.

The sliding scale insulin should be administered first because the client's fasting blood glucose level is significantly high at 345 mg/dL. This indicates that the client's blood sugar is not well controlled and immediate intervention is needed to bring it down to a safe level. Administering insulin before breakfast will help regulate the client's blood sugar and prevent potential complications associated with hyperglycemia.

The nurse should explain that completing a "down and dirty" assessment on each client soon after receiving report is the first priority during morning rounds. This type of assessment involves quickly assessing the client's vital signs, general appearance, and any immediate concerns or changes in their condition. By conducting this assessment, the nurse can identify any urgent needs or changes in the client's condition that require immediate attention. This allows the nurse to prioritize care and ensure that any necessary interventions are implemented promptly.

Tissue perfusion refers to the adequate blood flow to the tissues, organs, and cells in the body. Coronary artery disease (CAD) is a condition that affects the blood flow to the heart muscle due to the narrowing or blockage of the coronary arteries. This can lead to inadequate tissue perfusion in the heart, resulting in symptoms such as chest pain or angina. Therefore, a history of CAD can be considered an antecedent or a risk factor for impaired tissue perfusion.

Based on the given information that the client's telemetry reading is below, the nurse should continue to monitor the client. This suggests that the client's condition may not be critical or in need of immediate intervention. Continuing to monitor allows the nurse to observe any changes or improvements in the client's telemetry reading over time and make further decisions or interventions accordingly.

In this scenario, the nurse recognizes that the client is experiencing a cardiac arrest, as evidenced by the absence of respirations, pulse, and blood pressure. Pushing the Code Blue button is the correct action to take first as it activates the emergency response team and initiates the necessary interventions for resuscitation. This action ensures that immediate help is on the way to provide life-saving measures, such as CPR and defibrillation, to restore perfusion and circulation.

The correct answer is to have the client sit down. This is the most appropriate nursing action to implement first because it prioritizes the client's safety and comfort. By having the client sit down, it helps to reduce the risk of falls or further injury. It also allows the nurse to assess the client's condition and provide immediate assistance if needed. Calling a Code Blue may be necessary if the client's condition worsens, but it is not the first action to take in this situation. Assessing the telemetry reading and taking the client's apical pulse can be done after ensuring the client's immediate safety.

The nurse would question administering enalapril orally to a client with a blood pressure of 86/64 and an apical pulse of 65. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, but it can cause hypotension. Given the client's low blood pressure and heart rate, administering enalapril could further decrease blood pressure and potentially cause harm. The nurse should consult with the healthcare provider before administering the medication.

The nurse should teach the client to carry their nitroglycerin tablets in a brown bottle. Nitroglycerin is light-sensitive and can lose its potency if exposed to light. Using a brown bottle helps to protect the tablets from light and maintain their effectiveness.

The client diagnosed with chronic renal failure (CRF) requires hemodialysis to remove waste products and excess fluid from the body. Weighing the client before and after each treatment helps to assess the effectiveness of dialysis in removing fluid. Discussing the recommended fluid restriction is important to prevent fluid overload between treatments. Monitoring the hemodialysis access site continuously ensures its proper functioning and detects any complications. Providing potato chips or pretzels as a snack is not appropriate as they are high in sodium, which can worsen fluid retention. Keeping up a lively conversation during treatments is not a necessary intervention for the dialysis nurse to implement.

The client's symptoms of 2+ edema bilaterally of the lower extremities and crackles in all lung fields indicate fluid overload, which can be a serious complication of STEMI. Therefore, the nurse should prioritize notifying the healthcare provider (HCP) to ensure prompt intervention and management of the client's condition. This will allow the HCP to assess the client's condition, order appropriate interventions such as diuretics, and prevent further deterioration. Assessing the client's last meal, requesting a STAT 12 lead electrocardiogram, and administering furosemide IVP may be necessary interventions, but they should be implemented after notifying the HCP.

The nurse should question administering Erythropoietin because it was ordered to be given for three days, but it was only administered once yesterday. This medication should have been given again today, but there is no record of it being administered during the morning medication round.

Paroxysmal nocturnal dyspnea is a symptom commonly associated with congestive heart failure. It is characterized by sudden episodes of difficulty breathing during sleep, causing the client to wake up gasping for air. This symptom occurs due to fluid accumulation in the lungs, which impairs oxygenation and can be indicative of poor perfusion. Therefore, the presence of paroxysmal nocturnal dyspnea supports the concept of perfusion in a client diagnosed with congestive heart failure.

The priority concept in this scenario is perfusion. Coronary artery disease (CAD) and angina are both conditions that affect the blood flow to the heart. Perfusion refers to the adequate supply of oxygenated blood to the tissues and organs. In this case, ensuring proper perfusion is crucial to prevent further complications and provide optimal care for the client. Sleep, rest, activity, comfort, and oxygenation are all important aspects of nursing care, but in this specific situation, perfusion takes priority.

The nurse should implement going to the client's room and assessing the client personally first because it is important to directly evaluate the client's condition and gather more information before taking any further actions. By physically assessing the client, the nurse can obtain vital signs, assess the client's level of consciousness, and gather additional information that may help determine the appropriate next steps in the client's care. This allows for a more accurate and immediate response to the client's needs.

The client diagnosed with coronary artery disease complaining of severe indigestion should be assessed first because severe indigestion could be a symptom of a heart attack. Given the client's diagnosis and the severity of their symptoms, it is important for the nurse to prioritize their assessment and potentially intervene promptly to prevent any further complications.

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Maintaining the client's blood pressure greater than 100/60 is important in preventing the client from developing acute renal failure. Adequate blood pressure ensures sufficient perfusion to the kidneys, which is essential for their proper function. Acute renal failure can occur when there is inadequate blood flow to the kidneys, leading to ischemia and damage. By maintaining the client's blood pressure within the appropriate range, the nurse can help ensure adequate renal perfusion and reduce the risk of acute renal failure.

The client's low blood pressure and elevated heart rate indicate hypovolemia, which could be caused by the urinary tract infection. Increasing the normal saline IV fluids will help to restore fluid volume and improve blood pressure. This intervention should be implemented first to stabilize the client's condition. Notifying the health-care provider, hanging the antibiotic, or checking the urine culture can be done after addressing the immediate concern of hypovolemia.

The nurse should ask the client if the medication gives unwanted side effects first because this question directly addresses the client's decision to stop taking the medication. By understanding if the medication is causing unwanted side effects, the nurse can explore alternative treatment options or work with the client to manage the side effects effectively, thus improving medication adherence and addressing the client's perfusion issue.

The nurse should teach the client about when they can resume sexual activity after a myocardial infarction (MI). This is important because engaging in sexual activity can put strain on the heart, and it is essential for the client to understand when it is safe to do so. By discussing this with the client, the nurse can ensure that they have the necessary information to make informed decisions about their sexual activity and prevent any potential complications.

For a client diagnosed with heart failure, the nurse should implement several interventions. Requesting a dietary consult for a sodium-restricted diet is important to manage fluid retention and reduce strain on the heart. Instructing the client to elevate their feet during the day helps to reduce edema and improve circulation. Teaching the client to weigh themselves every morning wearing the same type of clothing allows for monitoring of fluid retention. Assessing for edema in dependent areas helps to identify any worsening of the condition. Having the client repeat back instructions to the nurse ensures understanding and compliance with the care plan.

The nurse should teach the client to wipe from front to back after voiding to prevent the spread of bacteria from the anal area to the urinary tract. Encouraging the client to drink cranberry juice each morning is also appropriate as it can help prevent urinary tract infections. Discussing the signs and symptoms of a recurrent infection is important for the client to be able to recognize and seek treatment promptly. Having the client fill a container of water to sip until at least 2,000 mL is consumed promotes frequent urination, which can help flush out bacteria from the urinary tract.

The nurse would assess for diabetes, hypertension, and race as antecedents in a client diagnosed with chronic renal failure (CRF). Diabetes and hypertension are common risk factors for developing CRF, as they can lead to damage in the kidneys over time. Race is also a known risk factor, as certain ethnicities, such as African Americans, have a higher prevalence of CRF. Assessing the client's current diet and fluid restrictions may be important in managing their condition, but they are not considered antecedents in this context.

The nurse should implement the interventions of monitoring the client's blood pressure and apical rate every four hours to assess for any changes in tissue perfusion. Placing the client on intake and output every shift will help the nurse monitor fluid balance and detect any signs of fluid overload or dehydration, which can impact tissue perfusion. Determining if the client is on an antiplatelet or anticoagulant medication is important as these medications can affect blood clotting and therefore tissue perfusion. Assessing the client's neurological status every shift and as needed is important to monitor for any changes in brain perfusion and potential complications.