Nursing Elites

1. What is the most common symptom of hypoglycemia that the nurse should teach the diabetic client to recognize?

• A. Nervousness
• B. Anorexia
• C. Kussmaul's respirations
• D. Bradycardia

Correct answer: A

Rationale: Nervousness is the most common symptom of hypoglycemia. It is often accompanied by other signs such as weakness, perspiration, confusion, and palpitations. Anorexia (lack of appetite) is not a typical symptom of hypoglycemia; it is more commonly associated with hyperglycemia. Kussmaul's respirations are a deep and labored breathing pattern seen in diabetic ketoacidosis, not hypoglycemia. Bradycardia (slow heart rate) is not a typical symptom of hypoglycemia; tachycardia (fast heart rate) is more commonly associated with hypoglycemia due to the release of catecholamines in response to low blood sugar.

2. A healthcare professional is reviewing the results of serum laboratory studies of a client with suspected hepatitis. Which increased parameter is interpreted as the most specific indicator of this disease?

• A. Hemoglobin
• B. Serum bilirubin
• C. Blood urea nitrogen (BUN)
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Serum bilirubin is the most specific indicator of hepatitis as it reflects liver dysfunction. Hemoglobin, blood urea nitrogen (BUN), and erythrocyte sedimentation rate (ESR) are not specific to hepatitis. Hemoglobin measures the oxygen-carrying capacity of red blood cells, BUN evaluates kidney function, and ESR is a nonspecific marker of inflammation or infection.

3. A client who underwent lobectomy 24 hours ago has not had any chest tube drainage for the past hour. What should the nurse do first?

• A. Contacts the physician
• B. Checks for kinks in the drainage system
• C. Checks the client’s blood pressure and heart rate
• D. Connects a new drainage system to the client’s chest tube

Correct answer: B

Rationale: When a chest tube is not draining, the nurse's initial action should be to check for kinks or clots in the chest drainage system. This step helps to ensure the patency of the system and allows for proper drainage. Checking the client's blood pressure and heart rate is important but not the priority when addressing a lack of chest tube drainage. Contacting the physician is warranted if signs of respiratory distress or mediastinal shift are observed after ruling out kinks or clots. Connecting a new drainage system is done when the fluid chamber is full, following a specific procedure to maintain a closed system and prevent complications.

4. Four days following an abdominal aortic aneurysm repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?

• A. Elevate extremities on pillows
• B. Evaluate edema for pitting
• C. Assess pulses with a vascular Doppler
• D. Wrap the feet with warmed blankets

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to assess pulses with a vascular Doppler. The absence of palpable pedal pulses following an abdominal aortic aneurysm repair raises concerns about compromised blood flow, which could lead to serious complications like ischemia or thrombosis. Evaluating and confirming the presence or absence of pulses is crucial to guide further interventions. Elevating extremities on pillows (Choice A) may be beneficial for managing edema, but it is not the immediate priority when pulses are not palpable. Evaluating edema for pitting (Choice B) can provide additional information about fluid status but does not address the primary concern of absent pulses. Wrapping the feet with warmed blankets (Choice D) is not appropriate in this situation and may not address the underlying vascular issue.

5. What information will the nurse provide when counseling a patient starting a sulfonamide drug for a urinary tract infection?

• A. Drink several quarts of water daily.
• B. If stomach upset occurs, avoid taking antacids.
• C. Limit sun exposure to avoid skin reactions.
• D. Report any sore throat promptly.

Correct answer: A

Rationale: The correct answer is A: Drink several quarts of water daily. This advice aims to prevent crystalluria, a potential side effect of sulfonamide drugs. Option B is incorrect because antacids should not be taken with sulfonamides as they can decrease drug absorption. Option C is incorrect as sulfonamides can increase sensitivity to sunlight, not requiring sun exposure limitations but sun protection measures. Option D is incorrect because a sore throat could indicate a more serious adverse effect and should be promptly reported for evaluation.

Similar Questions