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 client from a nursing home is admitted with urinary sepsis and has a single-lumen, peripherally-inserted central catheter (PICC). Four medications are prescribed for 9:00 a.m. and the nurse is running behind schedule. Which medication should the nurse administer first?

• A. Piperacillin/tazobactam (Zosyn) in 100 ml D5W, IV over 30 minutes q8 hours.
• B. Vancomycin (Vancocin) 1 gm in 250 ml D5W, IV over 90 minutes q12 hours.
• C. Pantoprazole (Protonix) 40 mg PO daily.
• D. Enoxaparin (Lovenox) 40 mg subq q24 hours.

Correct answer: A

Rationale: In a patient with urinary sepsis, administering Piperacillin/tazobactam first is crucial as it is an antibiotic that directly targets the infection. Addressing the infection promptly is essential to prevent its progression and complications. Vancomycin, Pantoprazole, and Enoxaparin are important medications for the patient's overall treatment plan, but in this scenario, the antibiotic should take precedence due to the urgency of managing the sepsis.

3. The nurse has completed the admission assessment of a client and has determined that the client's body mass index (BMI) is 33.5 kg/m2. What health promotion advice should the nurse provide to the client?

• A. It would be very helpful if you could integrate more physical activity into your routine.
• B. You're considered to be overweight, so you should be diligent about maintaining a healthy diet.
• C. You might want to consider some of the surgical options that have been developed for treating obesity.
• D. With your permission, I'd like you to refer to a support group for individuals who live with severe obesity.

Correct answer: A

Rationale: Increasing physical activity is a key component of managing BMI and overall health.

4. A 45-year-old obese man arrives at a clinic reporting daytime sleepiness, difficulty falling asleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

• A. Adenoiditis
• B. Chronic tonsillitis
• C. Obstructive sleep apnea
• D. Laryngeal cancer

Correct answer: C

Rationale: The symptoms described, including daytime sleepiness, difficulty falling asleep at night, and snoring, are classic signs of obstructive sleep apnea. This condition is commonly seen in obese individuals due to the relaxation of throat muscles during sleep, leading to airway obstruction. Adenoiditis and chronic tonsillitis are less likely as they don't typically present with the same symptoms mentioned.

5. During a home visit, the nurse should evaluate the adequacy of a client's COPD treatment by assessing for which primary symptom?

• A. Dyspnea
• B. Tachycardia
• C. Unilateral diminished breath sounds
• D. Edema of the ankles

Correct answer: A

Rationale: Assessing for dyspnea is crucial when evaluating COPD treatment effectiveness as it is a primary symptom of the condition. Dyspnea, or difficulty breathing, is a common and distressing symptom in COPD patients. Monitoring the severity of dyspnea can provide valuable insights into the client's response to treatment and disease progression.

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