Nursing Elites

1. The healthcare provider is assessing the client's use of medications. Which of the following medications may cause a complication with the treatment plan of a client with diabetes?

• A. Aspirin
• B. Steroids
• C. Sulfonylureas
• D. Angiotensin-converting enzyme (ACE) inhibitors

Correct answer: B

Rationale: The correct answer is B: Steroids. Steroids can induce hyperglycemia, complicating diabetes management by raising blood sugar levels. Aspirin is not typically associated with causing complications in diabetic clients. Sulfonylureas are oral antidiabetic medications that can lower blood sugar levels and are commonly used in diabetes management, making them beneficial rather than harmful. Angiotensin-converting enzyme (ACE) inhibitors are medications often prescribed to manage hypertension in diabetic clients and do not typically interfere with diabetes treatment plans.

2. The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom?

• A. Dizziness
• B. Dysuria
• C. Nausea
• D. Tinnitus

Correct answer: D

Rationale: The correct answer is D: Tinnitus. When furosemide and an aminoglycoside antibiotic are used together, there is an increased risk of ototoxicity. Tinnitus, a ringing in the ears, is a common early sign of ototoxicity. Dizziness (choice A) is a common side effect of furosemide but not specifically related to this drug interaction. Dysuria (choice B) is painful urination and is not directly associated with this drug combination. Nausea (choice C) is a common side effect of furosemide but is not specifically indicative of ototoxicity caused by the drug interaction.

3. The healthcare provider is unable to palpate the client's left pedal pulses. Which of the following actions should the healthcare provider take next?

• A. Auscultate the pulses with a stethoscope.
• B. Call the physician.
• C. Use a Doppler ultrasound device.
• D. Inspect the lower left extremity.

Correct answer: C

Rationale: When pedal pulses are not palpable, using a Doppler ultrasound device is the appropriate next step to locate the pulse. Auscultating the pulses with a stethoscope (Choice A) is used for assessing blood flow in arteries above the clavicle, not for pedal pulses. Calling the physician (Choice B) may be necessary at a later stage, but initially, using a Doppler ultrasound device to locate the pulse is more appropriate. Inspecting the lower left extremity (Choice D) can provide visual information but will not help in locating the pedal pulses, making it a less suitable option.

4. A client was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should a nurse expect to find?

• A. Blood urea nitrogen (BUN) of 52 mg/dL
• B. Creatinine of 2.3 mg/dL
• C. BUN of 10 mg/dL
• D. BUN/creatinine ratio of 8:1

Correct answer: A

Rationale: In cardiogenic shock, decreased renal perfusion leads to an elevated BUN. Choice A is correct. Creatinine remains normal in cardiogenic shock as it signifies kidney damage, which has not occurred in this case. A low BUN indicates overhydration, malnutrition, or liver damage, which are not typically seen in cardiogenic shock. A low BUN/creatinine ratio is associated with fluid volume excess or acute renal tubular acidosis, not specifically indicative of cardiogenic shock.

5. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse’s priority action?

• A. Calculate the mean arterial pressure (MAP).
• B. Ask for insertion of a pulmonary artery catheter.
• C. Take the client’s pulse.
• D. Slow down the normal saline infusion.

Correct answer: D

Rationale: The nurse should recognize that the client may be developing fluid overload and respiratory distress due to the rapid normal saline infusion. The priority action is to slow down the infusion to prevent worsening respiratory distress and potential fluid overload. While calculating the mean arterial pressure (MAP) is important to assess perfusion, addressing the immediate respiratory distress takes precedence. Inserting a pulmonary artery catheter would provide detailed hemodynamic information but is not the initial step in managing acute respiratory distress. Monitoring vital signs, including the client's pulse, is crucial after adjusting the intravenous infusion to ensure a safe response to the intervention.

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