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. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which finding requires immediate intervention?

• A. Oxygen saturation of 88%
• B. Respiratory rate of 24 breaths per minute
• C. Heart rate of 90 beats per minute
• D. Productive cough with green sputum

Correct answer: D

Rationale: In a client with COPD admitted with pneumonia, a productive cough with green sputum indicates a potential bacterial infection. Green sputum is commonly associated with bacterial pneumonia, which requires immediate intervention with appropriate antibiotics. Monitoring oxygen saturation, respiratory rate, and heart rate are essential in COPD patients, but the presence of green sputum suggests an urgent need for targeted treatment to address the underlying infection. Oxygen saturation of 88% is concerning but may not directly indicate the need for immediate intervention in the absence of other critical symptoms. Respiratory rate of 24 breaths per minute and a heart rate of 90 beats per minute are within normal limits and may not be indicative of an acute issue requiring immediate intervention in this context.

3. A public health nurse is planning a smoking cessation program for a local community. Which component is most important to include in the program?

• A. information on the health risks of smoking
• B. strategies for coping with withdrawal symptoms
• C. testimonials from former smokers
• D. distribution of nicotine replacement therapy

Correct answer: B

Rationale: The most important component to include in a smoking cessation program is strategies for coping with withdrawal symptoms. Withdrawal symptoms are a significant barrier to quitting smoking, and providing effective coping strategies can greatly increase the program's success. Choice A, providing information on the health risks of smoking, may be important but addressing withdrawal symptoms is more crucial. Testimonials from former smokers (Choice C) and distribution of nicotine replacement therapy (Choice D) are helpful but not as essential as addressing withdrawal symptoms directly.

4. The public health nurse is evaluating resources in a rural community. Which healthcare resource is most important for the community?

• A. family planning center
• B. accessibility to trauma care
• C. annual health fair
• D. weather-related disaster plan

Correct answer: B

Rationale: In rural areas, accessibility to trauma care is the most critical healthcare resource due to the longer emergency response times. Trauma care can be life-saving in situations where immediate medical attention is required for severe injuries. The other options, such as a family planning center, annual health fair, and weather-related disaster plan, are important but not as crucial as trauma care in addressing urgent health needs in a rural community.

5. Which client has the highest risk for developing community-acquired pneumonia?

• A. a 40-year-old first-grade teacher who works with underprivileged children
• B. a 75-year-old retired secretary with exercise-induced wheezing
• C. a 60-year-old homeless person who is an alcoholic and smokes
• D. a 35-year-old aerobics instructor who skips meals and eats only vegetables

Correct answer: C

Rationale: The correct answer is C, a 60-year-old homeless person who is an alcoholic and smokes. This client has the highest risk of developing community-acquired pneumonia due to multiple factors such as homelessness, substance abuse, and smoking. Homelessness can lead to poor living conditions and limited access to healthcare, increasing susceptibility to infections. Alcoholism and smoking weaken the immune system, making individuals more vulnerable to respiratory infections like pneumonia. Choices A, B, and D do not present the same level of risk factors for pneumonia compared to choice C.

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