Nursing Elites

1. A client with a history of diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which finding requires immediate intervention?

• A. Blood glucose of 200 mg/dL.
• B. Serum bicarbonate of 20 mEq/L.
• C. Blood pressure of 140/90 mm Hg.
• D. Urine output of 50 mL in 4 hours.

Correct answer: D

Rationale: In a client with diabetic ketoacidosis (DKA), urine output of 50 mL in 4 hours indicates oliguria, which is a concerning sign of decreased renal perfusion and potential renal failure. This finding requires immediate intervention to prevent further deterioration of kidney function.\n\nChoice A (Blood glucose of 200 mg/dL) is elevated but not the most urgent concern in this scenario. Choice B (Serum bicarbonate of 20 mEq/L) reflects metabolic acidosis, which is expected in DKA but does not require immediate intervention. Choice C (Blood pressure of 140/90 mm Hg) is slightly elevated but not acutely concerning in the context of DKA.

2. The nurse is assisting with the triage of clients at a large community disaster and finds a man lying on the ground, who states that the blast threw him out of a second-story window. Which action should the nurse implement first?

• A. Logroll the client to his side and assess for back injuries
• B. Perform a complete neurological assessment
• C. Open the client's airway immediately
• D. Place the nurse's hands around the client's neck to stabilize

Correct answer: C

Rationale: Opening the client's airway immediately is the priority in this scenario. Ensuring the airway is clear takes precedence over other actions as it is crucial for the client's breathing and oxygenation. Logrolling the client to assess for back injuries may worsen the condition if there are spinal injuries, so this should not be done as the first step. Performing a complete neurological assessment is important but not the immediate priority over ensuring the airway is clear. Placing the nurse's hands around the client's neck to stabilize is incorrect and could potentially harm the client, as neck stabilization should only be done if there is a suspected neck injury, which is not indicated in this case.

3. The healthcare professional is developing a safety program for older adults at a senior center. Which topic should the professional prioritize?

• A. medication management
• B. fall prevention
• C. fire safety
• D. emergency preparedness

Correct answer: B

Rationale: Fall prevention should be prioritized for older adults as falls are a significant cause of injury and hospitalization in this population. Addressing fall prevention measures can help reduce the risk of falls and improve the overall safety and well-being of older adults. Medication management, fire safety, and emergency preparedness are also important topics, but fall prevention takes precedence due to its direct impact on the health and safety of older adults.

4. The public health nurse is creating a plan to increase state funding for a local health clinic. Which strategy is likely to be most effective in obtaining funding for the clinic?

• A. Run the health clinic economically and promote the services the clinic provides.
• B. Organize concerned citizens to write letters and call state representatives.
• C. Highlight to the media the valuable services offered by the community clinic.
• D. Hire a professional lobbyist to convince Congress of the local clinic's value.

Correct answer: B

Rationale: Organizing concerned citizens to contact state representatives is likely the most effective strategy to secure state funding for the local health clinic. By mobilizing a group of citizens who are directly impacted by the clinic's services, the public health nurse can create a strong advocacy group that can influence decision-makers. Option A, running the health clinic economically and promoting its services, may be necessary but does not directly address the funding aspect. Option C, highlighting services to the media, may raise awareness but does not guarantee funding. Option D, hiring a professional lobbyist, may be costly and may not have the same grassroots impact as organizing citizens.

5. The nurse notices that the influenza immunization rate is much lower for certain demographic groups than for others. Which intervention is likely to be most useful in increasing the rates of immunization in the underserved community groups?

• A. designated clinics conveniently located in target neighborhoods
• B. reports on decreasing influenza rates during times of greatest prevalence
• C. legislative proposals that mandate influenza vaccinations for all
• D. radio announcements about the availability of the influenza vaccine

Correct answer: A

Rationale: Conveniently located clinics in target neighborhoods increase accessibility, making it easier for underserved community groups to receive influenza immunizations. This intervention directly addresses the issue of lower immunization rates by improving convenience and access. Reports on decreasing influenza rates (choice B) may not directly impact immunization rates. Legislative proposals mandating vaccinations (choice C) could face resistance and may not always be the most effective or practical solution. Radio announcements (choice D) may raise awareness but may not address the underlying barriers to immunization faced by underserved communities.

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