Nursing Elites

1. 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.

2. A nurse is assessing a postoperative client on an hourly basis. The nurse notes that the client’s urine output for the past hour was 25 mL. Based on this finding, the nurse first:

• A. Calls the physician
• B. Increases the rate of the IV infusion
• C. Checks the client’s overall intake and output record
• D. Administers a 250-mL bolus of normal saline solution (0.9%)

Correct answer: C

Rationale: Clients are at risk of hypovolemia postoperatively, and decreased urine output can be an early sign. However, to accurately interpret this finding, the nurse must assess the overall fluid balance by checking the client’s intake and output records. Increasing the IV infusion rate or administering a bolus of normal saline solution without a physician's order would not be appropriate as these interventions require a prescription. The physician should be notified once the nurse has collected all necessary assessment data, including fluid status and vital signs.

3. In a patient with type 1 diabetes, which of the following is a sign of diabetic ketoacidosis (DKA)?

• A. Polyuria
• B. Bradycardia
• C. Dry skin
• D. Tachycardia

Correct answer: D

Rationale: Tachycardia is a sign of diabetic ketoacidosis (DKA) in a patient with type 1 diabetes. In DKA, the body responds to hyperglycemia and dehydration by increasing heart rate. Polyuria (increased urination) is a symptom of diabetes but not specific to DKA. Bradycardia (slow heart rate) and dry skin are not typical signs of DKA; instead, tachycardia and other signs of volume depletion are more common.

4. What is the primary purpose of administering IV fluids to a patient in septic shock?

• A. To reduce blood pressure.
• B. To increase cardiac output.
• C. To stabilize blood glucose levels.
• D. To maintain adequate tissue perfusion.

Correct answer: D

Rationale: The primary purpose of administering IV fluids to a patient in septic shock is to maintain adequate tissue perfusion. In septic shock, there is a significant drop in blood pressure and systemic vascular resistance leading to poor tissue perfusion. IV fluids help to restore intravascular volume, improve perfusion to vital organs, and prevent organ failure. Choice A ('To reduce blood pressure') is incorrect because IV fluids in septic shock aim to restore tissue perfusion rather than lower blood pressure. Choice B ('To increase cardiac output') is incorrect as the primary goal is to improve tissue perfusion, not specifically increase cardiac output. Choice C ('To stabilize blood glucose levels') is unrelated to the primary purpose of administering IV fluids in septic shock, which is to address the compromised tissue perfusion.

5. A client with type 1 diabetes mellitus has a blood glucose level of 620 mg/dL. After the nurse calls the physician to report the finding and monitors the client closely for:

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: A

Rationale: In the scenario described, a client with a blood glucose level of 620 mg/dL and type 1 diabetes mellitus is at risk of developing metabolic acidosis. In type 1 diabetes, the lack of sufficient circulating insulin leads to an increase in blood glucose levels. As the body cells utilize all available glucose, the breakdown of fats for energy results in the production of ketones, leading to metabolic acidosis. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis are not typically associated with uncontrolled type 1 diabetes. Metabolic alkalosis is more commonly linked to conditions such as vomiting or excessive diuretic use, while respiratory acidosis and respiratory alkalosis are related to respiratory system imbalances in carbon dioxide levels.

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