Nursing Elites

1. During a home health visit, the nurse notices that an older male client with type 2 diabetes mellitus is wearing loose cloth slippers. The client reports that he cannot comfortably wear other shoes because his toenails get in the way. The nurse inspects the client's feet and finds long thick nails that curl down under some of the toes. Which action should the nurse take?

• A. demonstrate proper foot care to the client and family
• B. have a home health aide assist the client with hygiene weekly
• C. schedule an appointment for the client with a podiatrist
• D. trim the client's toenails gradually over several visits

Correct answer: C

Rationale: Scheduling an appointment with a podiatrist is the most appropriate action in this scenario. For a client with long thick nails that curl under the toes, professional foot care by a podiatrist is necessary to prevent complications, especially in a client with diabetes mellitus. Demonstrating proper foot care (choice A) may not address the immediate need for nail trimming. Having a home health aide assist with hygiene weekly (choice B) may not be sufficient for managing the client's toenail issue effectively. Trimming the client's toenails gradually over several visits (choice D) should be performed by a professional like a podiatrist to avoid potential complications.

2. The nurse is preparing to administer a scheduled dose of digoxin (Lanoxin) to a client. Which assessment finding should the nurse report to the healthcare provider?

• A. Heart rate of 90 beats per minute.
• B. Serum potassium level of 4.0 mEq/L.
• C. Blood pressure of 130/80 mm Hg.
• D. Client reports seeing halos around lights.

Correct answer: D

Rationale: Seeing halos around lights is a symptom of digoxin toxicity, which should be reported to the healthcare provider. This visual disturbance is a serious adverse effect of digoxin and indicates potential toxicity. Reporting this finding promptly is crucial to prevent further complications. Choices A, B, and C are within normal limits and do not indicate an immediate need for intervention related to digoxin administration.

3. The nurse is providing care for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory result requires immediate intervention?

• A. Serum sodium of 140 mEq/L.
• B. Serum potassium of 4.5 mEq/L.
• C. Serum osmolality of 280 mOsm/kg.
• D. Serum sodium of 130 mEq/L.

Correct answer: D

Rationale: The correct answer is D: Serum sodium of 130 mEq/L. In SIADH, there is excess release of antidiuretic hormone leading to water retention and dilutional hyponatremia. A serum sodium level of 130 mEq/L indicates severe hyponatremia, which can result in neurological symptoms, such as confusion, seizures, and coma. Therefore, immediate intervention is required to prevent further complications. Choice A, a serum sodium of 140 mEq/L, is within the normal range and does not require immediate intervention. Choice B, serum potassium of 4.5 mEq/L, is also within the normal range and is not directly related to SIADH. Choice C, serum osmolality of 280 mOsm/kg, is a measure of the concentration of solutes in the blood and may not be the most critical parameter to address in a client with SIADH and severe hyponatremia.

4. A home health nurse is reviewing the laboratory results for several clients with heart failure. Which client finding would the nurse report to the health care provider immediately?

• A. Total cholesterol 190
• B. Glycosylated hemoglobin of 7%
• C. B-type natriuretic peptide 550 pg/ml (more than 100 is concerning)
• D. Potassium 3.7

Correct answer: C

Rationale: An elevated B-type natriuretic peptide level indicates worsening heart failure, requiring immediate attention. This biomarker reflects the severity of heart failure and helps guide treatment decisions. Total cholesterol and glycosylated hemoglobin are important for assessing cardiovascular risk and diabetes management but are not indicative of acute heart failure exacerbation. A potassium level of 3.7 falls within the normal range and does not suggest an immediate concern in the context of heart failure.

5. A community health nurse is addressing the issue of elder abuse in the community. Which intervention should be prioritized?

• A. providing education on the signs of elder abuse
• B. setting up a support group for elder abuse survivors
• C. partnering with local law enforcement to increase patrols
• D. creating a confidential hotline for reporting abuse

Correct answer: D

Rationale: The prioritized intervention for addressing elder abuse in the community should be the creation of a confidential hotline for reporting abuse. A confidential hotline offers a safe and accessible way for individuals to report elder abuse and seek help promptly. Providing education on the signs of elder abuse (Choice A) is important but may not directly address immediate reporting and intervention needs. Setting up a support group for elder abuse survivors (Choice B) is beneficial for emotional support but may not address the primary need for reporting abuse. Partnering with local law enforcement to increase patrols (Choice C) focuses on prevention rather than providing a direct reporting mechanism for victims.

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