Nursing Elites

1. A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: D

Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.

2. The healthcare provider prescribes diagnostic tests for a client with pneumonia identified on a chest X-ray. Which diagnostic test should the nurse review for implementation to guide the most therapeutic treatment of pneumonia?

• A. Sputum culture and sensitivity
• B. Blood cultures
• C. Arterial blood gases (ABG)
• D. Computerized tomography (CT) of the chest

Correct answer: A

Rationale: Sputum culture and sensitivity is the most appropriate diagnostic test for pneumonia as it helps in identifying the causative organism, which is crucial for guiding the selection of the most effective antibiotic therapy. Blood cultures (choice B) are more useful in identifying systemic infections rather than pneumonia specifically. Arterial blood gases (ABG) (choice C) are helpful in assessing oxygenation but do not directly aid in identifying the causative organism. Computerized tomography (CT) of the chest (choice D) is useful for evaluating structural abnormalities in the lungs but is not the initial test of choice for diagnosing pneumonia.

3. A client has just regained bowel sounds after undergoing surgery. The physician has prescribed a clear liquid diet for the client. Which of the following items should the nurse ensure is available in the client’s room before allowing the client to drink?

• A. Straw
• B. Napkin
• C. Oxygen saturation monitor
• D. Suction equipment

Correct answer: D

Rationale: After surgery, when a client has just regained bowel sounds and is prescribed a clear liquid diet, the nurse needs to consider the possibility of impaired swallow reflexes due to anesthesia effects, leading to an increased risk of aspiration. Despite checking the gag and swallow reflexes before offering fluids, having suction equipment readily available in the client's room is essential to manage any potential aspiration risk. Therefore, the correct answer is suction equipment (choice D). Choices A, B, and C are incorrect because while a straw, napkin, and oxygen saturation monitor may be useful in other situations, they are not directly related to managing the risk of aspiration associated with offering fluids to a client post-surgery.

4. The client with diabetes mellitus should be cautioned by the nurse taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause which of the following?

• A. Hypokalemia.
• B. Hyperkalemia.
• C. Hypocalcemia.
• D. Disulfiram (Antabuse)-like symptoms.

Correct answer: D

Rationale: The correct answer is D: Disulfiram (Antabuse)-like symptoms. When a client with diabetes mellitus taking a sulfonylurea consumes alcohol, it can lead to disulfiram-like symptoms, such as nausea, flushing, and palpitations. Choice A, hypokalemia, is incorrect because sulfonylureas do not typically lead to low potassium levels. Choice B, hyperkalemia, is incorrect as sulfonylureas are not associated with high potassium levels. Choice C, hypocalcemia, is also incorrect because sulfonylureas are not known to cause low calcium levels.

5. Which information about mammograms is most important to provide a post-menopausal female client?

• A. Breast self-examinations are not necessary if annual mammograms are obtained.
• B. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron.
• C. Yearly mammograms should be done regardless of previous normal screenings.
• D. Women at high risk should have annual routine and ultrasound mammograms.

Correct answer: C

Rationale: The most important information to provide a post-menopausal female client regarding mammograms is that yearly mammograms should be done regardless of previous normal screenings. It is crucial for post-menopausal women to continue regular mammograms as they are at a higher risk for breast cancer. Option A is incorrect as breast self-examinations are still recommended in addition to mammograms. Option B is not the most important information compared to the importance of regular mammograms. Option D is not the most important advice for all post-menopausal females but specifically for those at high risk, indicating a more targeted approach.

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