Question

A client has been admitted through the Emergency Department with a diagnosis of renal calculi. While waiting for test results. the client cries out “can I please have something for pain?” Which nursing action is most appropriate?

Answer 1

Correct Answers:

Administer opioid analgesics as ordered.

Rationale :

💊 Renal colic causes severe visceral pain; the priority is rapid analgesia to reduce sympathetic surge and distress.

💊 Opioids (and/or NSAIDs like ketorolac) are guideline-supported for acute stone pain; give as ordered while continuing evaluation.

💊 Coaching, ambulation, or fluids do not address immediate pain and can be inappropriate before imaging/assessment (fluids may worsen obstruction discomfort).

💊 Effective pain control also enables positioning, imaging, and decision-making without movement-induced spikes in pain.

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Answer 2

Correct Answers:

Elevated acid levels
Diet high in animal protein
Frequent urinary tract infections (IJTIs)
Excessive intake of calcium based anacids

Rationale :

🪨 A. Elevated acid levels (uric acid) — MODIFIABLE

📌Hyperuricosuria and low urine pH promote uric acid stones and can nucleate calcium oxalate stones.

📌Management: reduce purine-rich foods (organ meats, certain fish), increase citrate (alkalinizes urine), and consider potassium citrate or allopurinol if indicated.

📌Aim for urine pH ~6–6.5 for uric-acid stone prevention.

📌Weight control and insulin sensitivity also help normalize acid-base balance in urine.

🪨 C. Diet high in animal protein — MODIFIABLE

📌High animal protein increases uric acid, calciuria, and reduces citrate (a natural stone inhibitor), raising risk for uric acid and calcium oxalate stones.

📌Counsel on moderation of animal protein, more plant proteins, and balanced meals with calcium + oxalate timing.

📌Excess sodium (often paired with protein diets) further increases urinary calcium—limit sodium to <2 g/day when possible.

📌Emphasize portion control rather than total elimination.

🪨 D. Frequent UTIs — MODIFIABLE

📌Recurrent infections with urease-producing bacteria (e.g., Proteus, Klebsiella) create alkaline urine and struvite (magnesium ammonium phosphate) stones.

📌Strategy: prompt diagnosis and treatment, consider urology for source control, and ensure complete stone removal to stop the infection-stone cycle.

📌Hydration and voiding habits support prevention; sometimes prophylaxis is considered.

📌Educate on recognizing early UTI symptoms and completing antibiotics.

🪨 E. Excessive intake of calcium-based antacids — MODIFIABLE

📌High-dose calcium carbonate supplements/antacids can increase urinary calcium, predisposing to calcium stones.

📌Nuance: Adequate dietary calcium (with meals) helps bind oxalate in the gut and reduce stone risk, but excess supplemental calcium is problematic.

📌Prefer dietary calcium over large, frequent supplements; if supplements are needed, take with meals and under guidance.

📌Avoid indiscriminate antacid use; review for GERD alternatives or other therapies.

🪨 F. Inadequate fluid intake — MODIFIABLE (strongest factor)

📌Low urine volume leads to supersaturation of stone-forming salts.

📌Target urine output > 2–2.5 L/day (usually needs ~2.5–3 L fluid/day, more with heat/exertion).

📌Include citrate-containing beverages (e.g., lemon/lime) to increase urinary citrate; limit sugary sodas (especially colas with phosphoric acid).

📌Teach distributed intake throughout the day and extra fluids with exercise or hot weather.

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Answer 3

Correct Answers:

The nurse calls the respiratory therapist to meet and educate the patient how to administer breathing treatments at home.

Rationale :

🤝 Collaboration means engaging interprofessional team members (e.g., respiratory therapy, pharmacy, PT/OT, case management) to coordinate care toward a shared patient goal—here, safe and effective home nebulizer use.

🤝 Involving the respiratory therapist (RT) integrates their specialized expertise in inhalation devices, technique, cleaning, and troubleshooting—improving self-management and reducing readmissions after a COPD flare.

🤝 Options A, B, and D are important but reflect independent nursing tasks (vital signs, assessment, medication administration), not collaboration with another discipline.

🤝 True collaboration also supports consistent education, aligns discharge planning, and ensures the patient gets hands-on teaching and return demonstration from the RT.

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Answer 4

Correct Answers:

Constipation or altered bowel habits
Abdominal distention and tenderness
Elevated white blood cell munt
Elevated temperature

Rationale :

✅ A. Constipation or altered bowel habits

🔹 Inflammation in the sigmoid colon often narrows the bowel lumen, leading to constipation.

🔹 Some clients may experience alternating constipation and diarrhea as the colon becomes irritated.

🔹 Patients may also report changes in stool caliber or a sensation of incomplete evacuation.

✅ B. Abdominal distention and tenderness

🔹 Inflammation and edema of the bowel wall cause tenderness on palpation, often localized to the left lower quadrant.

🔹 Distention develops due to slowed peristalsis and gas trapping within the intestines.

🔹 On physical exam, there may be guarding or rebound tenderness, especially in severe cases.

✅ D. Elevated white blood cell count

🔹 Active infection and inflammation stimulate the immune system, raising the WBC count.

🔹 This leukocytosis is a key diagnostic clue that supports the suspicion of diverticulitis.

🔹 It helps differentiate diverticulitis from non-inflammatory bowel changes.

✅ E. Elevated temperature

🔹 Fever develops as part of the systemic inflammatory response to infection of diverticula.

🔹 The rise in temperature reflects the presence of localized infection or possible abscess formation.

🔹 Persistent fever may indicate complications such as perforation or peritonitis.

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Answer 5

Correct Answers:

“The patent should splint their abdominal incision with pillow or folded blanket”
“The patient to wear ordered sequential compression devices (SCDs) to deep vein thrombosis (DVT)”
“The patient needs to blow into the incentive spirometer 8-10 breaths per hour while awake”

Rationale :

1. “The patient should splint their abdominal incision with a pillow or folded blanket.”

🟢 Incision support is vital because it reduces tension and pain on the surgical site during movement, coughing, or deep breathing.

🟢 Splinting helps prevent dehiscence (wound separation) by stabilizing the abdominal muscles.

🟢 It encourages the patient to perform essential activities such as coughing and deep breathing, which reduce the risk of pneumonia and atelectasis.

2. “The patient to wear ordered sequential compression devices (SCDs) to prevent deep vein thrombosis (DVT).”

🟢 Post-operative clients are at risk for venous stasis due to immobility, increasing the chance of DVT.

🟢 SCDs promote venous return in the lower extremities by rhythmically compressing the legs.

🟢 They are part of standard VTE prophylaxis after major abdominal surgery, often combined with early ambulation and anticoagulants if prescribed.

3. “The patient needs to blow into the incentive spirometer 8–10 breaths per hour while awake.”

🟢 Incentive spirometry promotes lung expansion, preventing atelectasis after general anesthesia.

🟢 It supports oxygen exchange and lowers the risk of post-op pneumonia.

🟢 Regular use encourages deep breathing and coughing, which keep secretions mobilized and prevent respiratory complications.

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Answer 6

Correct Answers:

4

Rationale :

Weight: 70 kg

Safe dose range (per dose): 0.05–0.2 mg/kg

Calculate minimum: 0.05 × 70 = 3.5 mg

Calculate maximum: 0.2 × 70 = 14 mg

Safe range in mg (per dose): 3.5–14 mg

Ordered dose: 4 mg IV q4h PRN

Is it safe? Yes — 4 mg is within the safe range (3.5–14 mg).

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Answer 7

Correct Answers:

100

Rationale :

Weight conversion: 22 lb ÷ 2.2 = 10 kg

Daily dose: 20 mg/kg/day × 10 kg = 200 mg/day

Dosing schedule: BID → 2 doses/day

Dose per administration: 200 mg/day ÷ 2 = 100 mg per dose

Answer: 100 mg per dose

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Answer 8

Correct Answers:

It is a severe vesicant and can cause tissue necrosis and even loss of limb.

Rationale :

🔹 Promethazine is highly caustic to blood vessels and surrounding tissue when administered IV.

🔹 If extravasation occurs, it can cause severe chemical irritation, tissue necrosis, and even gangrene requiring amputation.

🔹 Because of this risk, the IV route is generally avoided; safer alternatives are deep IM injection, rectal, or oral routes.

🔹 Guidelines recommend avoiding IV promethazine whenever possible to prevent catastrophic complications.

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Answer 9

Correct Answers:

Increased job satisfaction of the staff

Rationale :

🔹 Collaborative practice fosters open communication and teamwork among nurses, physicians, and other health professionals.

🔹 Research shows this approach improves the work environment, promotes mutual respect, and reduces professional burnout.

🔹 As a result, staff experience greater job satisfaction, which also supports better patient outcomes and retention.

🔹 Collaboration also enhances decision-making and ensures safer, more efficient care delivery.

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Answer 10

Correct Answers:

A nurse receives a sodium level from the lab: sodium 130. The nurse reads it back to the lab to confirm the result with patient identifiers.

Rationale :

🔹 The National Patient Safety Goals (NPSGs) emphasize accurate communication of critical lab results, requiring a read-back process to confirm accuracy.

🔹 Using two patient identifiers (such as name and date of birth) ensures the right patient is matched with the correct lab value.

🔹 This action directly supports patient safety by preventing miscommunication errors and ensuring timely interventions.

🔹 It reflects compliance with Joint Commission standards for effective communication and patient identification.

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QLexNursing

1 :
A client has been admitted through the Emergency Department with a diagnosis of renal calculi. While waiting for test results. the client cries out “can I please have something for pain?” Which nursing action is most appropriate?

2 :
A nurse is educating a client on risk factors for renal calculi (kidney stones). Which Of the following modifiable factors increase the client's risk of developing renal calculi? (Select all that apply.)

3 :
Nurses are caring for a patient experiencing an acute exacerbation of COPD Which action relates to the concept of Collaboration?

4 :
A client is admitted with a suspected diagnosis of diverticulitis. Which of the following clinical manifestations should the ruse expect to assess in this client? (Select all that apply.)

5 :
During a staff meeting. a nurse presented an in-service about post-op Hysterectomy care. What statement(s) by a novice nurse are correct? Which statement(s) are incorrect and require further teaching?

6 :
A patient is prescribed morphine 4 mg IV q4h PRN pain. The safe dose range is 0.05-0.2 mg/kg/dose. The patient weighs 70 kg. Is the ordered dose safe? Show the safe range in mg.

7 :
A child weighs 22 lb and is ordered amoxicillin 20 mg/kg/day The medication is ordered BID How many mg should the nurse administer per dose? Label your answer.

8 :
Why is promethazine (phenergan) intravenous route often avoided?

9 :
A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which Of the following research-based benefits is the nurse likely to identify as positive outcomes of collaboration?

10 :
Which scenario correctly demonstrates nursing care consistent with safety standards and National Patient Safety Goals?

QLexNursing

1 : A client has been admitted through the Emergency Department with a diagnosis of renal calculi. While waiting for test results. the client cries out “can I please have something for pain?” Which nursing action is most appropriate?

2 : A nurse is educating a client on risk factors for renal calculi (kidney stones). Which Of the following modifiable factors increase the client's risk of developing renal calculi? (Select all that apply.)

3 : Nurses are caring for a patient experiencing an acute exacerbation of COPD Which action relates to the concept of Collaboration?

4 : A client is admitted with a suspected diagnosis of diverticulitis. Which of the following clinical manifestations should the ruse expect to assess in this client? (Select all that apply.)

5 : During a staff meeting. a nurse presented an in-service about post-op Hysterectomy care. What statement(s) by a novice nurse are correct? Which statement(s) are incorrect and require further teaching?

6 : A patient is prescribed morphine 4 mg IV q4h PRN pain. The safe dose range is 0.05-0.2 mg/kg/dose. The patient weighs 70 kg. Is the ordered dose safe? Show the safe range in mg.

7 : A child weighs 22 lb and is ordered amoxicillin 20 mg/kg/day The medication is ordered BID How many mg should the nurse administer per dose? Label your answer.

8 : Why is promethazine (phenergan) intravenous route often avoided?

9 : A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which Of the following research-based benefits is the nurse likely to identify as positive outcomes of collaboration?

10 : Which scenario correctly demonstrates nursing care consistent with safety standards and National Patient Safety Goals?

1 :
A client has been admitted through the Emergency Department with a diagnosis of renal calculi. While waiting for test results. the client cries out “can I please have something for pain?” Which nursing action is most appropriate?

2 :
A nurse is educating a client on risk factors for renal calculi (kidney stones). Which Of the following modifiable factors increase the client's risk of developing renal calculi? (Select all that apply.)

3 :
Nurses are caring for a patient experiencing an acute exacerbation of COPD Which action relates to the concept of Collaboration?

4 :
A client is admitted with a suspected diagnosis of diverticulitis. Which of the following clinical manifestations should the ruse expect to assess in this client? (Select all that apply.)

5 :
During a staff meeting. a nurse presented an in-service about post-op Hysterectomy care. What statement(s) by a novice nurse are correct? Which statement(s) are incorrect and require further teaching?

6 :
A patient is prescribed morphine 4 mg IV q4h PRN pain. The safe dose range is 0.05-0.2 mg/kg/dose. The patient weighs 70 kg. Is the ordered dose safe? Show the safe range in mg.

7 :
A child weighs 22 lb and is ordered amoxicillin 20 mg/kg/day The medication is ordered BID How many mg should the nurse administer per dose? Label your answer.

8 :
Why is promethazine (phenergan) intravenous route often avoided?

9 :
A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which Of the following research-based benefits is the nurse likely to identify as positive outcomes of collaboration?

10 :
Which scenario correctly demonstrates nursing care consistent with safety standards and National Patient Safety Goals?