Nursing Elites

1. A client with a history of diabetes mellitus is admitted with a foot ulcer. The nurse should recognize that which intervention is most critical in promoting healing of the foot ulcer?

• A. Strict control of blood glucose levels.
• B. Regular dressing changes with sterile technique.
• C. Application of antibiotic ointment.
• D. Hydrotherapy treatment daily.

Correct answer: A

Rationale: In diabetic clients with foot ulcers, strict control of blood glucose levels is essential for promoting wound healing. High blood glucose levels can impair circulation and compromise the body's ability to fight infection, delaying the healing process. By maintaining optimal blood glucose levels, the client's overall health and wound healing potential are improved.

2. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be

• A. Antibiotic therapy with ciprofloxacin and metronidazole
• B. Referral for urgent colonoscopy
• C. Referral to a surgeon for immediate hemicolectomy
• D. Barium enema

Correct answer: A

Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

3. A client with a severe head injury is admitted to the intensive care unit (ICU). Which finding should the nurse report to the healthcare provider immediately?

• A. Urine output of 100 mL/hour.
• B. Intracranial pressure (ICP) of 20 mm Hg.
• C. Respiratory rate of 12 breaths/minute.
• D. Mean arterial pressure (MAP) of 70 mm Hg.

Correct answer: B

Rationale: An Intracranial Pressure (ICP) of 20 mm Hg is at the upper limit of normal and may indicate increased intracranial pressure, which is a critical finding in a client with a severe head injury. Elevated ICP can lead to further brain damage and must be addressed promptly to prevent complications such as herniation. Monitoring and managing ICP are crucial in the care of patients with head injuries in the ICU.

4. What instruction should the nurse include in the discharge teaching for a patient with hypothyroidism prescribed levothyroxine?

• A. Take the medication with meals.
• B. Take the medication in the morning on an empty stomach.
• C. Discontinue the medication if you feel better.
• D. Double the dose if a dose is missed.

Correct answer: B

Rationale: The correct instruction for a patient with hypothyroidism prescribed levothyroxine is to take the medication in the morning on an empty stomach to enhance absorption. Taking it with meals can interfere with absorption. Patients should not discontinue the medication without consulting their healthcare provider as it can lead to adverse effects. Doubling the dose if a dose is missed can increase the risk of side effects and overdosage. It is crucial for patients to follow the prescribed dosing schedule and consult their healthcare provider for any concerns or missed doses.

5. A client with Addison's disease is being treated with fludrocortisone (Florinef). Which electrolyte imbalance should the nurse monitor for?

• A. Hyperkalemia.
• B. Hyponatremia.
• C. Hypernatremia.
• D. Hypocalcemia.

Correct answer: C

Rationale: Fludrocortisone, such as Florinef, is a mineralocorticoid that promotes sodium retention and potassium excretion, which can lead to hypernatremia. Therefore, the nurse should closely monitor for hypernatremia when a client with Addison's disease is being treated with fludrocortisone. Hyperkalemia (Choice A) is incorrect because fludrocortisone promotes potassium excretion, leading to hypokalemia rather than hyperkalemia. Hyponatremia (Choice B) is incorrect as fludrocortisone promotes sodium retention. Hypocalcemia (Choice D) is unrelated to the action of fludrocortisone.

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