Nursing Elites

1. A 13-year-old girl, diagnosed with diabetes mellitus Type 1 at the age of 9, is admitted to the hospital in diabetic ketoacidosis. Which occurrence is the most likely cause of the ketoacidosis?

• A. Ate an extra peanut butter sandwich before gym class
• B. Incorrectly drew up and administered too much insulin
• C. Was not hungry, so she skipped eating lunch
• D. Has had a cold and ear infection for the past two days

Correct answer: B

Rationale: The correct answer is B. Incorrect insulin administration is a common cause of diabetic ketoacidosis. Administering too much insulin can lead to uncontrolled hyperglycemia, where the body starts breaking down fat for energy, resulting in the production of ketones. Choices A, C, and D are less likely to directly cause diabetic ketoacidosis. Eating an extra peanut butter sandwich, skipping lunch, or having a cold and ear infection would not directly lead to the metabolic derangements seen in diabetic ketoacidosis.

2. The healthcare provider receives a report on four clients who are complaining of increased pain. Which client requires immediate attention by the healthcare provider?

• A. Burning pain due to a Morton’s neuroma
• B. Sharp pain related to a crushed femur
• C. Paresthesia of fingers due to carpal tunnel syndrome
• D. Stinging pain related to plantar fasciitis

Correct answer: B

Rationale: Sharp pain related to a crushed femur indicates a severe condition and potential serious complications that require immediate attention. Crushed femur can lead to severe bleeding, nerve damage, or compartment syndrome, which are critical and life-threatening. The other choices, although painful, are less likely to present immediate life-threatening issues. Morton’s neuroma, carpal tunnel syndrome, and plantar fasciitis are painful conditions but are not typically associated with urgent, life-threatening complications like a crushed femur.

3. A nurse who works in the nursery is attending the vaginal delivery of a term infant. What action should the nurse complete before leaving the delivery room?

• A. Obtain the infant's vital signs.
• B. Observe the infant latching onto the breast.
• C. Administer a vitamin K injection.
• D. Place the ID bands on the infant and mother.

Correct answer: D

Rationale: Placing ID bands on the infant and mother is crucial to ensure correct identification and prevent mix-ups. This step is essential for maintaining proper identification of the newborn and the mother, facilitating safe care delivery. Before leaving the delivery room, ensuring proper identification is a priority to prevent any errors. Obtaining the infant's vital signs may be important but does not take precedence over ensuring correct identification. Observing the infant latching onto the breast is crucial for breastfeeding initiation but can be done after proper identification. Administering a vitamin K injection is also important but should not delay the immediate identification process.

4. The nurse is caring for a client who is receiving continuous ambulatory peritoneal dialysis (CAPD) and notes that the output flow is 100ml less than the input flow. Which actions should the nurse implement first?

• A. Continue to monitor intake and output with the next exchange
• B. Check the client's blood pressure and serum bicarbonate levels
• C. Irrigate the dialysis catheter
• D. Change the client's position

Correct answer: D

Rationale: In this situation, the priority action for the nurse is to change the client's position. Altering the client's position can help facilitate better fluid drainage in peritoneal dialysis, potentially resolving the issue without the need for more invasive interventions. Continuing to monitor intake and output (Choice A) is important but addressing the immediate drainage issue takes precedence. Checking blood pressure and serum bicarbonate levels (Choice B) is not directly related to the observed output flow discrepancy. Irrigating the dialysis catheter (Choice C) should not be the initial action as it is more invasive and should be considered only if repositioning does not resolve the issue.

5. A female client with breast cancer who completed her first chemotherapy treatment today at an outpatient center is preparing for discharge. Which behavior indicates that the client understands her care needs?

• A. Rented movies and borrowed books to use while passing time at home
• B. Discussing dietary restrictions with the nurse
• C. Arranging follow-up appointments with her oncologist
• D. Reporting to the nurse any new or worsening symptoms

Correct answer: D

Rationale: The correct answer is D because reporting any new or worsening symptoms to the nurse is crucial for the early detection of potential complications. This behavior shows that the client understands the importance of monitoring her health status post-chemotherapy treatment. Choices A, B, and C are incorrect because while renting movies, borrowing books, discussing dietary restrictions, and arranging follow-up appointments are all important aspects of care, the most critical factor immediately after chemotherapy is to monitor and report any new or worsening symptoms to healthcare providers.

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