Nursing Elites

1. A client who is anxious about an impending surgery is at risk for respiratory alkalosis. For which signs and symptoms of respiratory alkalosis 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: C

Rationale: The correct answer is C: Tachypnea, dizziness, and paresthesias. When a client is anxious, they may hyperventilate, leading to respiratory alkalosis. Tachypnea (rapid breathing) is a common sign of respiratory alkalosis. Dizziness and paresthesias (tingling or numbness in the extremities) are also typical symptoms. Choices A, B, and D are incorrect. Disorientation and dyspnea (Choice A) are not specific signs of respiratory alkalosis. Drowsiness, headache, and tachypnea (Choice B) may be more indicative of other conditions. Dysrhythmias and decreased respiratory rate and depth (Choice D) are not consistent with the expected signs of respiratory alkalosis.

2. The home health nurse provides teaching about insulin self-injection to a client who was recently diagnosed with diabetes mellitus. When the client begins to perform a return demonstration of an insulin injection into the abdomen, which instruction should the nurse provide?

• A. Select a different injection site
• B. Continue with the insulin injection
• C. Keep the skin flat rather than bunched
• D. Lie down flat for better skin exposure

Correct answer: B

Rationale: Choosing to continue with the insulin injection is the correct instruction in this scenario because it allows the client to demonstrate proper technique and reinforces their learning. Selecting a different injection site (choice A) is not necessary if the client is injecting into the abdomen as it is a suitable site. Keeping the skin flat rather than bunched (choice C) is a good practice but is not the priority in this situation where the client is demonstrating the injection technique. Lying down flat for better skin exposure (choice D) is not required and may not be practical for the client during routine self-injections.

3. A 49-year-old female client arrives at the clinic for an annual exam and asks the nurse why she becomes excessively diaphoretic and feels warm during nighttime. What is the nurse's best response?

• A. Explain the effects of follicle-stimulating and luteinizing hormones.
• B. Discuss perimenopause and related comfort measures.
• C. Assess lung fields and check for a cough productive of blood-tinged mucus.
• D. Inquire if a fever above 101°F (38.3°C) has occurred in the last 24 hours.

Correct answer: B

Rationale: The correct answer is B. The symptoms described by the client, excessive diaphoresis and feeling warm at night, are characteristic of perimenopause. During this period, lower estrogen levels lead to surges in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), resulting in vasomotor instability, night sweats, and hot flashes. Therefore, discussing perimenopause and related comfort measures with the client is essential to provide education and support. Choice A is incorrect because explaining the effects of FSH and LH alone does not directly address the client's current symptoms. Choice C is irrelevant as it focuses on assessing lung fields and cough symptoms, which are not related to the client's menopausal symptoms. Choice D is not the best response as it is more focused on ruling out fever as a cause, which is not typically associated with the symptoms described by the client.

4. In assessing cancer risk, which woman is at greatest risk of developing breast cancer?

• A. A 35-year-old multipara who never breastfed.
• B. A 50-year-old whose mother had unilateral breast cancer.
• C. A 55-year-old whose mother-in-law had bilateral breast cancer.
• D. A 20-year-old whose menarche occurred at age 9.

Correct answer: B

Rationale: The correct answer is B because family history of breast cancer, specifically in the mother, is a significant risk factor for developing breast cancer. The age of 50 is also a risk factor for breast cancer. Choice A is less likely as breastfeeding can actually reduce the risk of breast cancer. Choice C is less relevant since the risk is higher with a direct family member. Choice D, although early menarche is a risk factor, the age of the individual is much lower compared to the other age-related risk factors.

5. A client is scheduled to undergo computerized tomography (CT) with contrast for evaluation of an abdominal mass. The nurse should tell the client that:

• A. The test may be painful
• B. The test takes 2 to 3 hours
• C. Food and fluids are not allowed for 4 hours after the test
• D. Dye is injected and may cause a warm flushing sensation

Correct answer: D

Rationale: The correct answer is D. A contrast-aided CT scan involves the injection of dye to enhance the images obtained. The dye may cause a warm flushing sensation when injected, which is a common side effect. Choices A, B, and C are incorrect. CT with contrast is generally not a painful procedure, the duration of the test does not usually take 2 to 3 hours, and restrictions on food and fluids are typically before the test, not afterward.

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