A nurse is caring for a patient with chronic kidney disease (CKD). What is the priority nursing intervention?

Correct Answer: D

Rationale: The correct answer is D: Administer IV morphine. In CKD, pain management is crucial due to associated complications. Administering IV morphine helps alleviate pain effectively. Diuretics (A) are not indicated in CKD as they can worsen kidney function. Administering IV fluids (B) should be done cautiously to prevent fluid overload. Encouraging mobility and range of motion (C) is important for overall health but not the priority in this case.

Correct Answer: B

Rationale: The correct answer is B: Administer insulin. In a patient with CKD experiencing fluid retention, insulin is the priority action. Insulin helps to regulate blood glucose levels, which can impact fluid balance in the body. High blood glucose levels can lead to osmotic diuresis, causing fluid retention. Administering insulin helps to lower blood glucose levels, which in turn can help reduce fluid retention. Choice A: Administer diuretics - While diuretics can help with fluid retention, in a patient with CKD, using diuretics without addressing the underlying cause (high blood glucose levels) can worsen kidney function. Choice C and D: Administer IV fluids - Administering more fluids would exacerbate the fluid retention issue in a patient with CKD. It is important to address the underlying cause of fluid retention first.

Correct Answer: B

Rationale: The correct answer is B: Start an IV so contrast media may be given. This is the correct preparation for a patient suspected of having a pulmonary embolus because a CT pulmonary angiography, a common diagnostic test for pulmonary embolism, requires the administration of intravenous contrast media to visualize the pulmonary arteries effectively. Option A (Ensure that the patient has been NPO) is incorrect because being NPO (nothing by mouth) is not necessary for this specific diagnostic test. Option C (Inform radiology that radioactive glucose preparation is needed) is incorrect because radioactive glucose preparation is not used for diagnosing pulmonary embolism. Option D (Instruct the patient to expect to inspire deeply and exhale forcefully) is incorrect as this instruction is not relevant to preparing for a CT pulmonary angiography. Educationally, understanding the rationale behind the correct preparation for diagnostic testing is crucial for nurses to provide optimal care for patients. Knowing the specific requirements for different diagnostic tests ensures efficient and accurate patient management. This knowledge also demonstrates the nurse's competency in understanding the procedures involved in diagnosing conditions like pulmonary embolism, ultimately contributing to improved patient outcomes.

Correct Answer: A

Rationale: In the context of a patient who has undergone a total laryngectomy and radical neck dissection, monitoring the incision for bleeding is the priority nursing action in the first 24 hours post-surgery. This is crucial as these surgical procedures carry a high risk of bleeding due to the extensive tissue manipulation involved. Maintaining adequate IV fluid intake (Option B) is important for overall patient hydration and support, but it is not the priority in this immediate postoperative period where monitoring for complications takes precedence. Keeping the patient in semi-Fowler's position (Option C) is generally a good practice to promote respiratory function and reduce the risk of aspiration, but it is not the priority over monitoring for potential bleeding complications in the immediate postoperative phase. Teaching the patient to suction the tracheostomy (Option D) is not appropriate in the immediate postoperative period as the surgical site needs time to heal, and suctioning should be performed by trained healthcare professionals to prevent complications. Educationally, it is important for nurses to understand the critical nature of postoperative monitoring in high-risk surgeries like laryngectomy and neck dissection. This case highlights the significance of prioritizing assessments and interventions based on the specific needs of the patient to ensure optimal outcomes and prevent potential complications.

Correct Answer: C

Rationale: The correct answer is C) Ask the patient whether medications have been taken as directed. Rationale: Correct Answer (C): This option is correct because non-adherence to the prescribed TB medication regimen is a common reason for persistent positive sputum smears. By asking the patient about their medication adherence, the nurse can identify if the treatment failure is due to improper drug intake. Addressing non-adherence is crucial before considering changes to the treatment plan. Incorrect Answers: A) Teaching about drug-resistant TB may be necessary if non-adherence is ruled out as the reason for treatment failure. However, it is not the immediate next step in this scenario. B) While directly observed therapy (DOT) can help monitor medication adherence, it is typically implemented after confirming non-adherence rather than as the initial action. D) Discussing the need for an injectable antibiotic with the healthcare provider is premature without first assessing the patient's adherence to the current oral medication regimen. Educational Context: Understanding the importance of patient compliance in TB treatment is vital for nurses caring for patients with this infectious disease. By prioritizing the assessment of medication adherence, nurses can address a common challenge in TB management and ensure better treatment outcomes. This scenario highlights the significance of thorough patient assessment and tailored interventions in managing TB effectively.