Nursing Elites

1. A client with diabetes mellitus is experiencing diabetic ketoacidosis (DKA). What laboratory result should the nurse monitor closely?

• A. White blood cell count of 15,000.
• B. Blood glucose level of 320 mg/dL.
• C. Sodium level of 145 mEq/L.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: B

Rationale: A blood glucose level of 320 mg/dL indicates the need for insulin to manage diabetic ketoacidosis.

2. A client reports gastrointestinal upset after taking oral tetracycline. Which snack should the nurse recommend?

• A. Yogurt with fruit
• B. Toast with jelly
• C. Crackers with peanut butter
• D. Oatmeal with raisins

Correct answer: B

Rationale: The correct answer is B: Toast with jelly. Tetracycline can cause gastrointestinal upset when taken with dairy products. Yogurt with fruit (Choice A) contains dairy, which can worsen the gastrointestinal upset. Crackers with peanut butter (Choice C) and oatmeal with raisins (Choice D) are also not the best choices as they may not be gentle enough on the stomach. Toast with jelly is a simple snack that does not contain dairy and is less likely to exacerbate the gastrointestinal upset.

3. A client tells the nurse, 'I have something very important to tell you if you promise not to tell.' The best response by the nurse is

• A. I must document and report any information.
• B. I can't make such a promise.
• C. That depends on what you tell me.
• D. I must report everything to the treatment team.

Correct answer: B

Rationale: The correct answer is B because the nurse cannot promise confidentiality in this context. It is essential to prioritize the safety and well-being of the client and others. Certain information, such as harm to oneself or others, must be reported to ensure appropriate interventions are taken. Choice A is incorrect because while documentation is important, confidentiality cannot be guaranteed in this situation. Choice C is incorrect as the nurse should not make promises that may conflict with their professional responsibilities. Choice D is incorrect as reporting everything to the treatment team without discretion may breach client confidentiality.

4. A client with a chest tube following a pneumothorax is complaining of increased shortness of breath. What is the nurse's first action?

• A. Check for kinks in the chest tube tubing.
• B. Assess the client's lung sounds.
• C. Elevate the head of the bed to 30 degrees.
• D. Prepare for chest tube replacement.

Correct answer: C

Rationale: The correct first action for a client with a chest tube experiencing increased shortness of breath is to elevate the head of the bed to 30 degrees. This position promotes lung expansion, improves oxygenation, and can help relieve shortness of breath. Checking for kinks in the chest tube tubing would be important but not the first action in this situation. Assessing the client's lung sounds is also important but not the initial priority. Preparing for chest tube replacement is not indicated based solely on the client's complaint of increased shortness of breath.

5. A client at 12 weeks gestation is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Which action is most important for the nurse to implement?

• A. Provide emotional support
• B. Monitor daily weight
• C. Encourage small frequent meals
• D. Initiate prescribed intravenous fluids

Correct answer: D

Rationale: Hyperemesis gravidarum, characterized by severe nausea and vomiting, leads to dehydration and electrolyte imbalances. The priority intervention is initiating IV fluids to correct these imbalances. Providing emotional support is important for the client's well-being, but addressing fluid and electrolyte imbalances takes precedence. Monitoring daily weight and encouraging small frequent meals are beneficial interventions but are not the priority when managing hyperemesis gravidarum.

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