Nursing Elites

1. Which of the following statements should be included in the teaching to a client about a do-not-resuscitate order (DNR)?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians are required to write DNR orders.
• C. A DNR order can be written after discussion with the client and family.
• D. A court decision is needed for a DNR.

Correct answer: C

Rationale: The correct statement to include in teaching a client about a do-not-resuscitate (DNR) order is that it can be written after discussion with the client and family. This involves ensuring that the client and their family understand the implications and make an informed decision. Choice A is incorrect as pronouncing clinical death is not directly related to discussing a DNR order. Choice B is incorrect as while physicians typically write DNR orders, it is not a strict requirement. Choice D is incorrect as a court decision is not typically required for a DNR order; it is a decision made by the client with input from healthcare providers and family members.

2. Which instruction about insulin administration should Nurse Kate give to a client?

• A. Always follow the same order when drawing up different insulins into the syringe.
• B. Shake the vials before withdrawing the insulin.
• C. Store unopened vials of insulin in the refrigerator at recommended temperatures.
• D. Discard the intermediate-acting insulin if it appears cloudy.

Correct answer: A

Rationale: The correct answer is A. Consistently following the same order when drawing up different insulins helps to prevent medication errors. Option B is incorrect because shaking insulin vials could cause bubbles to form, leading to inaccurate dosing. Option C is incorrect as insulin should be stored in the refrigerator, not the freezer, to maintain its effectiveness. Option D is incorrect because cloudy appearance in intermediate-acting insulin may indicate the presence of insulin crystals, which can affect its potency, but this does not necessarily mean it should be discarded without consulting a healthcare provider.

3. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

• A. Fluid intake is less than 2,500 ml/day
• B. Urine output measures more than 200 ml/hour
• C. Blood pressure is 90/50 mm Hg
• D. The heart rate is 126 beats/minute

Correct answer: A

Rationale: The correct outcome indicating effective treatment of diabetes insipidus in a male client is a fluid intake of less than 2,500 ml/day. In diabetes insipidus, excessive urination causes increased fluid intake to compensate for the fluid loss. By effectively managing the condition, the client's fluid intake should decrease. Choices B, C, and D do not directly reflect the effectiveness of treatment for diabetes insipidus. Increased urine output (choice B) may indicate inadequate control of the condition, while low blood pressure (choice C) and a high heart rate (choice D) are not specific indicators of effective treatment for diabetes insipidus.

4. The nurse is caring for a client with hyperaldosteronism. Which of the following laboratory results would the nurse expect?

• A. Hypokalemia
• B. Hypernatremia
• C. Hyperkalemia
• D. Hypocalcemia

Correct answer: A

Rationale: In hyperaldosteronism, there is an excess of aldosterone production, leading to increased sodium retention and potassium excretion by the kidneys. This results in hypokalemia (low potassium levels). Therefore, the correct answer is hypokalemia (Choice A). Hypernatremia (Choice B) is an incorrect choice as hyperaldosteronism primarily affects potassium and not sodium levels. Hyperkalemia (Choice C) is also incorrect because hyperaldosteronism causes potassium excretion, leading to low levels. Hypocalcemia (Choice D) is not typically associated with hyperaldosteronism; instead, it is more related to conditions affecting calcium regulation.

5. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?

• A. Cool, clammy skin
• B. Distended neck veins
• C. Increased urine osmolarity
• D. Decreased serum sodium level

Correct answer: C

Rationale: Increased urine osmolarity is the best assessment finding supporting a nursing diagnosis of Deficient fluid volume in a male client with hyperglycemia. In hyperglycemia, there is increased glucose in the blood, which leads to osmotic diuresis. This results in the excretion of large amounts of urine that is concentrated (high osmolarity), leading to dehydration and fluid volume deficit. Cool, clammy skin (Choice A) is more indicative of poor perfusion, distended neck veins (Choice B) are associated with fluid volume excess, and decreased serum sodium level (Choice D) could be a result of dilutional hyponatremia due to fluid overload rather than deficient fluid volume.

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