Nursing Elites

1. A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

• A. Kussmaul's respirations and a fruity odor on the breath
• B. Shallow respirations and severe abdominal pain
• C. Decreased respirations and increased urine output
• D. Cheyne-Stokes respirations and foul-smelling urine

Correct answer: A

Rationale: In diabetic ketoacidosis (DKA), as the condition progresses, the body tries to compensate for the acidic environment by increasing the respiratory rate, leading to Kussmaul's respirations. The accumulation of ketones in the body causes a fruity odor on the breath. Option A is correct because Kussmaul's respirations and a fruity odor on the breath are classic signs of DKA. Option B is incorrect because shallow respirations are not typically seen in DKA, and severe abdominal pain is more commonly associated with conditions like pancreatitis. Option C is incorrect as decreased respirations are not a typical finding in DKA, and increased urine output is more commonly seen in conditions like diabetes insipidus. Option D is incorrect because Cheyne-Stokes respirations are not characteristic of DKA, and foul-smelling urine is not a prominent symptom in this condition.

2. Which patient is at greatest risk for papilledema?

• A. An elderly patient with cataracts and macular degeneration
• B. A male patient with hypothyroidism
• C. A male patient with hyperthyroidism
• D. An adolescent with a closed head injury

Correct answer: D

Rationale: An adolescent with a closed head injury is at the highest risk for papilledema due to increased intracranial pressure. Papilledema is often a consequence of elevated intracranial pressure, which can occur in conditions like head trauma. Choices A, B, and C do not directly correlate with an increased risk of papilledema compared to a closed head injury, which is more likely to lead to elevated intracranial pressure and subsequent papilledema.

3. A nurse is caring for a client who is unconscious and whose partner is their health care surrogate. The partner wishes to discontinue the client's feeding tube, but another family member tells the nurse that they want the client to continue receiving treatment. Which of the following responses should the nurse make?

• A. You should contact the provider about your wishes for your family member.
• B. We'll need to have the nursing supervisor review the client's advance directives.
• C. You should speak with the facility's ethics committee about your concerns.
• D. As the health care surrogate, the client's partner can make this decision.

Correct answer: D

Rationale: The correct response is D because the health care surrogate, as designated by the client, has the legal authority to make healthcare decisions on behalf of the client when they are unable to do so. This authority includes decisions about treatment continuation or withdrawal. Option A is incorrect as the family member's wishes do not override the legal authority of the health care surrogate. Option B is not the most appropriate action in this situation as the advance directives are already clear by the designation of a health care surrogate. Option C is not necessary at this stage since the health care surrogate can make the decision without involving the ethics committee.

4. Select all of the risk factors that are associated with deep vein thrombosis.

• A. The use of oral contraceptives
• B. Type B and O blood
• C. Rh negative blood
• D. Underweight

Correct answer: A

Rationale: The correct answer is A: "The use of oral contraceptives." Risk factors for deep vein thrombosis include factors such as immobility, surgery, cancer, obesity, smoking, and the use of oral contraceptives. Choices B, C, and D are incorrect because blood type and Rh factor do not play a role in the development of deep vein thrombosis, and being underweight is not typically considered a risk factor for this condition.

5. A client with a tumor refuses surgery, but the client's partner wants it. Which is the deciding factor in determining if the surgery will be done?

• A. Whether the partner is the client's durable power of attorney for healthcare
• B. Whether the client understands the risk of refusing the procedure
• C. Whether the client's refusal is based on religious belief
• D. Whether the facility's ethical committee reaches a consensus on the case

Correct answer: B

Rationale: The correct answer is B because the client's understanding of the risks involved in refusing the surgery is crucial in determining the course of action. In this scenario, the client's autonomy and decision-making capacity take precedence. Choice A is not directly relevant to the decision-making process regarding surgery. Choice C, religious beliefs, may influence the decision but should not be the determining factor in this case. Choice D involving the facility's ethical committee is not typically involved in individual patient care decisions.

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