Nursing Elites

1. The nurse is caring for a client with diabetic ketoacidosis (DKA). Which intervention is most important?

• A. Administer insulin as prescribed.
• B. Monitor the client's urine output.
• C. Assess the client's level of consciousness.
• D. Obtain an arterial blood gas (ABG) sample.

Correct answer: A

Rationale: Administering insulin is the most crucial intervention in managing diabetic ketoacidosis. Insulin helps reduce blood glucose levels and correct metabolic acidosis, which are the primary issues in DKA. Monitoring urine output (Choice B) is important but not as critical as administering insulin. Assessing the client's level of consciousness (Choice C) is essential but does not directly address the underlying cause of DKA. Obtaining an arterial blood gas sample (Choice D) can provide valuable information but is not as urgent as administering insulin to address the immediate metabolic imbalance.

2. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which laboratory value requires immediate intervention?

• A. Serum potassium of 6.5 mEq/L
• B. Serum sodium of 135 mEq/L
• C. Serum creatinine of 2.0 mg/dL
• D. Blood glucose of 150 mg/dL

Correct answer: A

Rationale: A serum potassium level of 6.5 mEq/L is most concerning in a client with CKD as it indicates severe hyperkalemia, requiring immediate intervention. Hyperkalemia can lead to life-threatening cardiac arrhythmias. Serum sodium levels within the normal range (135 mEq/L) are not immediately concerning. Serum creatinine of 2.0 mg/dL may indicate impaired kidney function but does not require immediate intervention for hyperkalemia. Blood glucose of 150 mg/dL is within normal limits and does not directly correlate with hyperkalemia in this scenario.

3. After multiple attempts to stop drinking, an adult male is admitted to the medical intensive care unit (MICU) with delirium tremens. He is tachycardic, diaphoretic, restless, and disoriented. Which finding indicates a life-threatening condition?

• A. Widening QRS complexes and flat T waves
• B. Tachycardia and elevated blood pressure
• C. Restlessness and anxiety
• D. Diaphoresis and dehydration

Correct answer: A

Rationale: The correct answer is A: Widening QRS complexes and flat T waves. In the context of an adult male with delirium tremens and symptoms like tachycardia, diaphoresis, restlessness, and disorientation, the presence of widening QRS complexes and flat T waves on an ECG suggests severe electrolyte imbalance, particularly hypokalemia. This severe electrolyte imbalance can lead to life-threatening arrhythmias such as ventricular tachycardia or fibrillation. Tachycardia and elevated blood pressure (choice B) can be expected in delirium tremens but do not directly indicate a life-threatening condition as widening QRS complexes and flat T waves do. Restlessness and anxiety (choice C) are common symptoms of delirium tremens but do not specifically signify a life-threatening condition. Diaphoresis and dehydration (choice D) are also common in delirium tremens but do not directly point towards a life-threatening electrolyte imbalance as widening QRS complexes and flat T waves do.

4. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour?

• A. 50 ml/hour
• B. 25 ml/hour
• C. 75 ml/hour
• D. 100 ml/hour

Correct answer: C

Rationale: To calculate the infusion rate, convert 1 mg to 1,000 mcg (1 mg = 1,000 mcg) and then use the formula D/H x Q, where D is the desired dose, H is the dose on hand, and Q is the quantity of solution. In this case, it would be 300 mcg/hour / 1,000 mcg x 250 ml = 75 ml/hour. Therefore, the nurse should program the infusion pump to deliver 75 ml/hour. Choice A (50 ml/hour), Choice B (25 ml/hour), and Choice D (100 ml/hour) are incorrect as they do not correspond to the calculated rate of 75 ml/hour.

5. Which breakfast selection indicates that the client understands the nurse's instructions about the dietary management of osteoporosis?

• A. Egg whites, toast, and coffee.
• B. Bran muffin, mixed fruits, and orange juice.
• C. Granola and grapefruit juice.
• D. Bagel with jelly and skim milk.

Correct answer: D

Rationale: The correct answer is D, 'Bagel with jelly and skim milk.' This choice includes skim milk, a good source of calcium, which is important for osteoporosis management. It also avoids foods that inhibit calcium absorption. Osteoporosis dietary management emphasizes increased calcium intake and reducing foods that hinder calcium absorption. Choice A only provides proteins but lacks calcium. Choice B offers fruits and a bran muffin, but it lacks a good source of calcium. Choice C has granola but misses a significant source of calcium.

Similar Questions