Nursing Elites

1. A client is admitted with diabetic ketoacidosis (DKA). Which assessment finding requires immediate intervention?

• A. Fruity breath odor.
• B. Blood glucose of 450 mg/dL.
• C. Deep, rapid respirations.
• D. Serum potassium of 5.2 mEq/L.

Correct answer: C

Rationale: The correct answer is C: Deep, rapid respirations (Kussmaul breathing). This is a sign of severe acidosis commonly seen in diabetic ketoacidosis (DKA) and requires immediate intervention. Kussmaul breathing helps to compensate for the metabolic acidosis by blowing off carbon dioxide. Prompt intervention is necessary to prevent further deterioration and potential respiratory failure. Fruity breath odor (Choice A) is a classic sign of DKA but does not require immediate intervention. While a blood glucose level of 450 mg/dL (Choice B) is high, it does not pose an immediate threat to the client's life. Serum potassium of 5.2 mEq/L (Choice D) is slightly elevated but not the most critical finding that requires immediate intervention in this scenario.

2. A 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The combination of pruritus, jaundice, and xanthomas, along with elevated cholesterol and alkaline phosphatase levels, is classic for primary biliary cirrhosis. Pruritus is often the initial symptom, followed by jaundice due to cholestasis. Xanthomas, elevated cholesterol, and alkaline phosphatase levels are also common findings in primary biliary cirrhosis. Primary sclerosing cholangitis and pancreatic cancer may present with similar symptoms but are less likely in this clinical context.

3. Prior to elective surgery, a patient taking warfarin should receive which instruction regarding warfarin therapy?

• A. Continue taking warfarin until the day of surgery.
• B. Stop taking warfarin three days before surgery.
• C. Switch to aspirin before surgery.
• D. Stop taking warfarin one week before surgery.

Correct answer: D

Rationale: Prior to elective surgery, a patient taking warfarin should be instructed to stop taking warfarin around one week before the procedure. This timeframe allows for the effects of warfarin to diminish, lowering the risk of excessive bleeding during surgery. Continuing warfarin until the day of surgery (Choice A) increases the risk of bleeding complications. Stopping warfarin three days before surgery (Choice B) may not provide enough time for the anticoagulant effects to subside. Switching to aspirin before surgery (Choice C) is not recommended as a substitute for warfarin in this context.

4. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

5. An 89-year-old male client complains to the nurse that people are whispering behind his back and mumbling when they talk to him. What age-related condition is likely to be occurring with this client?

• A. Delirium
• B. Presbyopia
• C. Presbycusis
• D. Cerebral dysfunction

Correct answer: C

Rationale: The correct answer is C, Presbycusis. Presbycusis is age-related hearing loss that often affects the ability to hear high-pitched sounds, making speech appear mumbled. This condition is common in older adults and can lead to difficulties in understanding conversations, as in the case of the client complaining about people whispering and mumbling.

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