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. During an interview with a client planning elective surgery, the client asks the nurse, 'What is the advantage of having a preferred provider organization insurance plan?' Which response is best for the nurse to provide?

• A. Neither plan allows the selection of healthcare providers or hospitals.
• B. There are fewer healthcare providers to choose from than in an HMO plan.
• C. An individual may select healthcare providers from outside of the PPO network.
• D. An individual can become a member of a PPO without belonging to a group.

Correct answer: C

Rationale: The best response for the nurse to provide is option C, as it highlights a key advantage of a preferred provider organization (PPO) insurance plan. By stating that an individual may select healthcare providers from outside of the PPO network, the nurse emphasizes the flexibility and freedom of choice that PPO plans offer. This feature allows individuals to seek care from providers who are not part of the PPO network, albeit at a higher cost. Option A is incorrect because both PPO and HMO plans allow the selection of healthcare providers, although with different restrictions. Option B is incorrect as PPO plans typically offer a larger selection of healthcare providers compared to HMO plans. Option D is incorrect as membership in a PPO usually requires affiliation with a group, such as through employment or membership in an organization.

3. The client with chronic kidney disease (CKD) is being taught about the necessary sodium restriction in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?

• A. I am thrilled that I can continue to eat fast food.
• B. I will cut out bacon with my eggs every morning.
• C. My cooking style will change by not adding salt.
• D. I will probably lose weight by cutting out potato chips.

Correct answer: A

Rationale: Choice A, 'I am thrilled that I can continue to eat fast food,' indicates a lack of understanding as fast food is typically high in sodium, which is detrimental for individuals with CKD. The client should be advised to avoid fast food due to its high sodium content. Choices B, C, and D demonstrate a good understanding of the need for sodium restriction in the diet to prevent complications associated with CKD. Cutting out bacon, avoiding salt in cooking, and eliminating high-sodium snacks like potato chips are all positive steps towards managing CKD.

4. The client who experiences angina has been advised to follow a low-cholesterol diet. Which of the following meals would be best?

• A. Hamburger, salad, and milkshake.
• B. Baked liver, green beans, and coffee.
• C. Spaghetti with tomato sauce, salad, and coffee.
• D. Fried chicken, green beans, and skim milk.

Correct answer: C

Rationale: The best meal option for a client with angina following a low-cholesterol diet is spaghetti with tomato sauce, salad, and coffee. This meal is lower in cholesterol content compared to the other options provided. Hamburger with salad and milkshake, baked liver with green beans and coffee, and fried chicken with green beans and skim milk are higher in cholesterol and may not be suitable for an individual with angina who needs to adhere to a low-cholesterol diet.

5. A patient has a serum potassium level of 2.7 mEq/L. The patient’s provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?

• A. As a single-dose 200 mEq oral tablet
• B. As an intravenous bolus over 15 to 20 minutes
• C. In an intravenous solution at a rate of 10 mEq/hour
• D. In an intravenous solution at a rate of 45 mEq/hour

Correct answer: C

Rationale: For a patient with severe hypokalemia with a serum potassium level of 2.7 mEq/L requiring 200 mEq of potassium replacement, the appropriate route of administration would be intravenous. Potassium chloride should be administered slowly to prevent adverse effects; therefore, the correct option is to administer the potassium in an intravenous solution at a rate of 10 mEq/hour. Choices A and B are incorrect because potassium should not be given as a single-dose oral tablet or as an intravenous bolus over a short period of time due to the risk of adverse effects. Choice D is also incorrect as the rate of 45 mEq/hour exceeds the recommended maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L, which is 10 mEq/hour.

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