Nursing Elites

1. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which clinical finding requires immediate intervention?

• A. Serum glucose of 300 mg/dL
• B. Serum potassium of 5.5 mEq/L
• C. Serum bicarbonate of 18 mEq/L
• D. Positive urine ketones

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L indicates metabolic acidosis in a client with DKA, requiring immediate intervention. In DKA, the body produces excess ketones, leading to metabolic acidosis, which is reflected by a low serum bicarbonate level. Correcting the low serum bicarbonate is crucial to normalize the metabolic acidosis and improve the client's condition. While elevated serum glucose (choice A) and urine ketones (choice D) are characteristic of DKA, addressing the metabolic acidosis takes precedence. Serum potassium (choice B) levels may also need monitoring and management, but correcting the acidosis is the priority to prevent complications like cardiovascular collapse.

2. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value is most concerning?

• A. INR of 3.0
• B. Prothrombin time (PT) of 15 seconds
• C. Hemoglobin of 10 g/dl
• D. White blood cell count

Correct answer: A

Rationale: An INR of 3.0 is most concerning in a client prescribed warfarin (Coumadin) as it indicates a high risk of bleeding, requiring immediate intervention. A high INR value suggests that the blood is taking longer to clot, putting the patient at an increased risk of hemorrhage. Prothrombin time (PT) measures how long it takes for blood to clot, but the specific value of 15 seconds is within the normal range. Hemoglobin of 10 g/dl indicates mild anemia and does not directly relate to the risk of bleeding associated with warfarin therapy. White blood cell count assesses immune function and infection risk, but it is not directly related to the anticoagulant effects of warfarin.

3. A female client with type 2 diabetes reports that she has been taking her medications as prescribed but her blood glucose levels remain elevated. Which action should the nurse take first?

• A. Check the client's current blood glucose level.
• B. Assess the client's diet and medication adherence.
• C. Review the client's medication list for potential interactions.
• D. Obtain a hemoglobin A1c level.

Correct answer: C

Rationale: The correct action the nurse should take first is to review the client's medication list for potential interactions. This step is crucial as it can help identify any medications that might be contributing to the elevated blood glucose levels. Checking the current blood glucose level (choice A) is important but not the first action to address the ongoing issue. Assessing the client's diet and medication adherence (choice B) is also important, but reviewing the medication list should be the initial step to rule out any drug-related causes. Obtaining a hemoglobin A1c level (choice D) is a valuable assessment but may not address the immediate need to identify potential medication interactions.

4. The nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory value requires immediate intervention?

• A. Serum glucose of 300 mg/dL
• B. Serum potassium of 4.5 mEq/L
• C. Serum bicarbonate of 15 mEq/L
• D. Serum pH of 7.28

Correct answer: D

Rationale: A serum pH of 7.28 indicates metabolic acidosis in a client with diabetic ketoacidosis (DKA), requiring immediate intervention. In DKA, the body produces excess ketones, leading to acidosis. Monitoring and correcting the pH level is crucial in managing DKA. Serum glucose levels may be high in DKA, but the immediate concern is correcting the acidosis to prevent complications. Serum potassium and bicarbonate levels are also important but not as immediately critical as correcting the acidosis in DKA.

5. The nurse is caring for a client who is postoperative following a thyroidectomy. Which assessment finding is most concerning?

• A. Slight difficulty swallowing
• B. Hoarse voice
• C. Positive Chvostek's sign
• D. Pain at the incision site

Correct answer: C

Rationale: A positive Chvostek's sign is the most concerning assessment finding as it suggests hypocalcemia, which is a potential complication following thyroidectomy. Hypocalcemia can lead to serious complications such as tetany and laryngospasm. Immediate intervention is required to prevent further complications. Choices A, B, and D are common post-thyroidectomy findings and are expected during the immediate postoperative period. Slight difficulty swallowing may be due to postoperative swelling, a hoarse voice may be temporary due to intubation trauma, and pain at the incision site is normal after surgery.

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