Nursing Elites

1. The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse's response?

• A. Electrical energy fields
• B. Spinal column manipulation
• C. Mind-body balance
• D. Exercise of joints

Correct answer: B

Rationale: The focus of the nurse's response should be on spinal column manipulation when discussing chiropractic treatment for illnesses. Chiropractic theory emphasizes that misalignment of the vertebrae can interfere with the transmission of mental impulses between the brain and body organs, leading to diseases. Manipulation is aimed at reducing such misalignments, known as subluxations. While mind-body balance and exercise of joints are important aspects of holistic health, in the context of chiropractic treatment, the key intervention is spinal column manipulation to address vertebral misalignments. Therefore, choices A, C, and D are incorrect as they do not directly address the primary focus of chiropractic treatment.

2. A client with asthma is being admitted for breathing difficulties. His arterial blood gas results are pH 7.26, PCO2 49, PaO2 90, and HCO3- 21. Which of the following best describes this condition?

• A. Uncompensated respiratory acidosis
• B. Compensated respiratory alkalosis
• C. Uncompensated metabolic acidosis
• D. Compensated metabolic alkalosis

Correct answer: A

Rationale: In this case, the client's arterial blood gas results show a pH of 7.26 and a PCO2 of 49, both of which are abnormal. A pH below the normal range of 7.35-7.45 indicates acidosis. The elevated PCO2 of 49 mmHg suggests respiratory acidosis as the primary issue. The normal range for PCO2 is 35-45 mmHg, so a value of 49 indicates the retention of excess CO2, leading to acidosis. The low HCO3- level of 21 also supports the presence of metabolic acidosis; however, the primary abnormality is respiratory, making this an uncompensated respiratory acidosis. Therefore, the correct answer is 'Uncompensated respiratory acidosis.' Choice B, 'Compensated respiratory alkalosis,' is incorrect because the client's pH is acidic, not alkalotic. Additionally, there is no compensation occurring for the primary respiratory acidosis indicated by the elevated PCO2. Choice C, 'Uncompensated metabolic acidosis,' is incorrect because while the HCO3- level is low, the primary issue indicated by the elevated PCO2 is respiratory acidosis. Choice D, 'Compensated metabolic alkalosis,' is incorrect since the arterial blood gas results do not support a metabolic alkalosis. The low HCO3- level would typically be seen in metabolic acidosis, but in this case, the primary issue is respiratory acidosis.

3. Mr. W has orders for a physical therapy consult. The nurse contacts the appropriate department but 12 hours later, no one has come to see the client. Which is the most appropriate action of the nurse?

• A. Call the supervisor and file a complaint against the physical therapy department
• B. Contact the physician to notify him that the orders were not carried out
• C. Assess the client's activity level by assisting with ambulation using a gait belt
• D. Contact the physical therapy department again and repeat the order

Correct answer: D

Rationale: In this situation, the most appropriate action for the nurse to take is to contact the physical therapy department again and repeat the order. It is crucial to ensure that the client receives the necessary care as prescribed. Following up with the department reinforces the importance of the order and increases the likelihood of prompt action. Option A is incorrect because escalating the situation to filing a complaint should be a last resort after all other communication attempts have failed. Option B is not the best course of action as the first step should be to ensure proper communication within the healthcare team. Option C is not the priority in this scenario, as the immediate concern is to address the delay in the physical therapy consult.

4. Mr. Freeman has difficulty getting out of bed. The nurse should encourage Mr. Freeman to ______________.

• A. ask for assistance before getting out of bed.
• B. remain in bed because it is safer and he will not fall.
• C. instruct him to stand up quickly from the bed.
• D. lean forward and push up and off the bed.

Correct answer: A

Rationale: The nurse should encourage Mr. Freeman to use his call bell and ask for assistance before getting out of bed. This can prevent him from falling. Patients should not stay in bed; they should be encouraged to get out of bed as much as possible to prevent complications like pressure ulcers and muscle weakness. Instructing a patient to stand up quickly from the bed is unsafe as it can lead to dizziness and falls. Similarly, leaning forward and pushing off the bed can increase the risk of falls and should be avoided. Asking for assistance is the safest and most appropriate option to ensure patient safety and prevent accidents.

5. Mrs. M has had diabetes for seven years. She has worked hard to control her blood glucose levels and watch her dietary intake. Her physician orders a hemoglobin A1C test. Which of the following best describes the action of this test?

• A. The test determines if the client is anemic and needs iron supplements
• B. The test determines if there is excess glucose building up in the urine
• C. The test determines the amount of hemoglobin reaching the liver to support gluconeogenesis
• D. The test determines the amount of hemoglobin that is coated with glucose

Correct answer: D

Rationale: A hemoglobin A1C test, also known as a glycated hemoglobin test, determines the amount of hemoglobin that is coated with glucose. Excess glucose in the bloodstream may cause it to attach to hemoglobin on red blood cells. Because the life of these cells is between 2 and 3 months, the hemoglobin A1C is an accurate measurement of a client's glucose during that time. Choices A, B, and C are incorrect. Choice A relates to anemia and iron supplements, which are not assessed by a hemoglobin A1C test. Choice B mentions excess glucose in the urine, which is typically assessed through a urine glucose test, not the hemoglobin A1C test. Choice C is incorrect as the test is not related to the amount of hemoglobin reaching the liver to support gluconeogenesis; instead, it specifically measures the amount of hemoglobin that is glycated or coated with glucose.

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