Nursing Elites

1. A client goes to the Emergency Department with acute respiratory distress and the following arterial blood gases (ABGs): pH 7.35, PCO2 40 mmHg, PO2 63mmHg, HCO3 23, and oxygenation saturation (SAO2) 93%. Which of the following represents the best analysis of the etiology of these ABGs?

• A. tuberculosis (TB)
• B. pneumonia
• C. pleural effusion
• D. hypoxia

Correct answer: D

Rationale: A combined low PO2 and low SAO2 indicates hypoxia. The pH, PCO2, and HCO3 are normal. ABGs are not necessarily altered in TB or pleural effusion. In pneumonia, the PO2 and PCO2 might be low because hypoxia stimulates hyperventilation, but the best analysis in this case is hypoxia due to the combination of low PO2 and low SAO2.

2. What is the best lab test to diagnose disseminated intravascular coagulation (DIC)?

• A. platelet count
• B. prothrombin time (PT)
• C. partial thromboplastin time (PTT)
• D. D-dimer

Correct answer: D

Rationale: The best lab test to diagnose disseminated intravascular coagulation (DIC) is the D-dimer test. In DIC, numerous small clots form throughout the body and are rapidly broken down. D-dimer measures a specific fibrin split product and is the most specific test for DIC. Platelet count (Choice A) is decreased in DIC due to consumption, but it is not specific for diagnosing DIC. Prothrombin time (PT - Choice B) and partial thromboplastin time (PTT - Choice C) are both elevated in DIC because clotting factors have been used up, but they are not specific for DIC as they can be elevated in other conditions as well.

3. What is the number one reason a person with alcohol addiction does not seek treatment?

• A. Co-dependency
• B. Denial
• C. Depression
• D. Stigma

Correct answer: B

Rationale: The correct answer is B: Denial. Individuals with alcohol addiction often deny that they have a drinking problem and may become defensive when confronted about it. This sense of denial can be a significant barrier to seeking treatment. Co-dependency, referred to in choice A, is a relationship dynamic and is not the primary reason for avoiding treatment. Depression, as mentioned in choice C, is a common co-occurring condition with alcohol addiction but is not typically the main factor preventing treatment-seeking. Stigma, as in choice D, can act as a deterrent, but denial of the problem itself is usually the primary obstacle to seeking help.

4. A nurse gave medications to the wrong client. She stated the client responded to the name called. What is the nurse's appropriate documentation?

• A. Note in medication records the drug given
• B. The client was not hurt, no need for documentation
• C. Note the client's orientation
• D. Completely fill out an incident report

Correct answer: D

Rationale: In the case where medications are given to the wrong client, the appropriate documentation by the nurse should involve completely filling out an incident report. This report is essential for tracking errors, implementing corrective measures, and ensuring patient safety. Choice A is incorrect because solely noting the drug given does not address the severity of the error. Choice B is incorrect because even if the client was not hurt, documentation is crucial for quality improvement and risk prevention. Choice C is incorrect as noting the client's orientation does not adequately address the medication error and its implications.

5. What are the major electrolytes in the extracellular fluid?

• A. potassium and chloride
• B. potassium and phosphate
• C. sodium and chloride
• D. sodium and phosphate

Correct answer: C

Rationale: The correct answer is sodium and chloride. These two electrolytes are the major components of extracellular fluid. Potassium and phosphate (Choice B) are not the major electrolytes in the extracellular fluid. Potassium is primarily an intracellular ion, and phosphate is more abundant in the intracellular fluid and bones. Sodium and phosphate (Choice D) are also not the major electrolytes in the extracellular fluid. Chloride plays a crucial role in maintaining electrolyte balance and is predominantly found in extracellular fluid alongside sodium.

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