Nursing Elites

1. The parents of a 6-year-old recently diagnosed with asthma should be taught that symptoms of an acute episode of asthma are due to which physiological response?

• A. Inflammation of the mucous membrane and bronchospasm
• B. Increased mucus production and airway obstruction
• C. Hyperinflation of the lungs and alveolar collapse
• D. Bronchoconstriction and airway inflammation

Correct answer: D

Rationale: The correct answer is D: Bronchoconstriction and airway inflammation. During an acute asthma episode, bronchoconstriction and airway inflammation occur, leading to difficulty breathing. Choices A, B, and C are incorrect. Inflammation of the mucous membrane and bronchospasm (Choice A) are part of the pathophysiology of asthma but do not fully explain the symptoms during an acute episode. Increased mucus production and airway obstruction (Choice B) are also seen in asthma but are not the primary cause of acute symptoms. Hyperinflation of the lungs and alveolar collapse (Choice C) are not typical features of an acute asthma episode.

2. A client who is receiving long-term steroid therapy complains of blurred vision. Which intervention should the nurse implement first?

• A. Instruct the client to use artificial tears to lubricate the eyes
• B. Administer an ophthalmic antibiotic as prescribed
• C. Arrange for the client to see an optometrist for an eye exam
• D. Notify the healthcare provider immediately

Correct answer: D

Rationale: The correct answer is to notify the healthcare provider immediately (Option D). Blurred vision in a client on long-term steroid therapy can be a sign of serious conditions like cataracts or glaucoma, which need urgent medical evaluation and management. Instructing the client to use artificial tears (Option A) may help with dry eyes but does not address the underlying cause of blurred vision. Administering an ophthalmic antibiotic (Option B) is not indicated unless there is a specific infection present. Referring the client to an optometrist for an eye exam (Option C) may delay necessary medical intervention by the healthcare provider, who should be involved promptly in this situation.

3. A client with chronic renal failure (CRF) is placed on a protein-restricted diet. Which nutritional goal supports this dietary change?

• A. Reduce production of urea nitrogen (BUN)
• B. Decrease the risk of hyperkalemia
• C. Promote healing of injured nephrons
• D. Promote the elimination of albumin

Correct answer: A

Rationale: The correct answer is A: Reduce production of urea nitrogen (BUN). A protein-restricted diet is essential for clients with chronic renal failure to decrease the production of urea nitrogen, as the kidneys cannot effectively excrete it. This helps in managing the accumulation of waste products in the body. Choices B, C, and D are incorrect. Choice B is not directly related to a protein-restricted diet but focuses on managing potassium levels. Choice C is not a direct nutritional goal of a protein-restricted diet but aims at supporting kidney function. Choice D is not a target of a protein-restricted diet but relates more to managing protein loss in the urine.

4. 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.

5. A client with type 2 diabetes is admitted with hyperglycemic hyperosmolar syndrome (HHS). Which clinical finding is most concerning?

• A. Serum glucose of 500 mg/dl
• B. Blood pressure of 140/90 mmHg
• C. Serum osmolarity of 320 mOsm/kg
• D. Serum pH of 7.30

Correct answer: C

Rationale: A serum osmolarity of 320 mOsm/kg is the most concerning finding in a client with hyperglycemic hyperosmolar syndrome (HHS). This level of osmolarity indicates severe dehydration and hyperosmolarity, putting the client at risk of complications like organ failure. Immediate intervention is crucial to address the dehydration and restore fluid balance. The other options, while important in the overall assessment of a client with HHS, do not directly indicate the severity of dehydration and hyperosmolarity seen with a high serum osmolarity level.

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