Nursing Elites

1. A client with a history of diabetes mellitus is admitted with a blood glucose level of 600 mg/dl and is unresponsive. Which intervention should the nurse implement first?

• A. Administer 50% dextrose IV push.
• B. Administer insulin as prescribed.
• C. Monitor the client's urine output.
• D. Obtain a blood glucose level.

Correct answer: A

Rationale: Administering 50% dextrose IV push is the first priority in treating a blood glucose level of 600 mg/dl in a client who is unresponsive due to hyperglycemia. This intervention is crucial to rapidly raise the client's blood glucose levels and address the emergency situation. Administering insulin (Choice B) would further lower the blood glucose level, worsening the client's condition. Monitoring urine output (Choice C) and obtaining a blood glucose level (Choice D) are important assessments but are secondary to the immediate need to address the high blood glucose levels causing the client's unresponsiveness.

2. To reduce the risk of being named in a malpractice lawsuit, which action is most important for the nurse to take?

• A. Adhere consistently to standards of care.
• B. Thoroughly document all client interactions.
• C. Build a good rapport with clients.
• D. Work closely with the healthcare team.

Correct answer: A

Rationale: Adhering consistently to standards of care is crucial for nurses to reduce the risk of being named in a malpractice lawsuit. Following established protocols and guidelines ensures that the care provided is safe and effective. Thoroughly documenting all client interactions is also essential to support the care provided and to have a record of the interventions. Building a good rapport with clients is important for communication and trust but does not directly reduce the risk of malpractice. Working closely with the healthcare team is valuable for collaboration but might not directly impact the risk of malpractice unless it relates to following standards of care.

3. A client with a history of chronic kidney disease is scheduled for a CT scan with contrast. Which laboratory value should the nurse review before the procedure?

• A. Serum potassium
• B. Blood urea nitrogen (BUN)
• C. Serum creatinine
• D. Serum glucose

Correct answer: C

Rationale: Before a CT scan with contrast, the nurse should review the serum creatinine level. This is crucial in assessing kidney function because contrast agents can potentially worsen renal function, leading to contrast-induced nephropathy. Monitoring serum creatinine helps in identifying patients at risk and taking necessary precautions. Serum potassium (Choice A) is important in conditions like hyperkalemia but is not the priority before a contrast CT scan. Blood urea nitrogen (BUN) (Choice B) is another renal function test but is not as specific as serum creatinine for assessing kidney function. Serum glucose (Choice D) is important in monitoring blood sugar levels, especially in diabetic patients, but it is not directly related to the risk of contrast-induced nephropathy in this scenario.

4. The healthcare provider explains through an interpreter the risks and benefits of a scheduled surgical procedure to a non-English speaking female client. The client gives verbal consent, and the healthcare provider leaves, instructing the nurse to witness the signature on the consent form. The client and the interpreter then speak together in the foreign language for an additional 2 minutes until the interpreter concludes, 'She says it is OK.' What action should the nurse take next?

• A. Ask for a full explanation from the interpreter of the witnessed discussion.
• B. Have the client sign the consent form.
• C. Document the conversation and witness the consent.
• D. Ask the client directly if she has any questions.

Correct answer: A

Rationale: The correct action for the nurse to take next is to ask for a full explanation from the interpreter of the witnessed discussion. Verbal consent is not sufficient; it is crucial to ensure that the client fully comprehends the risks and benefits of the surgical procedure. By asking the interpreter to provide a detailed explanation of the discussion, the nurse can confirm that the client has given informed consent. Having the client sign the consent form (Choice B) without ensuring complete understanding may lead to potential misunderstandings. Documenting the conversation and witnessing the consent (Choice C) is not enough to guarantee the client's comprehension. Asking the client directly if she has any questions (Choice D) may not be effective if language barriers persist.

5. A male client is admitted with a bowel obstruction and intractable vomiting for the last several hours despite the use of antiemetics. Which intervention should the nurse implement first?

• A. Infuse 0.9% sodium chloride 500 ml bolus
• B. Administer an antiemetic intravenously
• C. Insert a nasogastric tube
• D. Prepare the client for surgery

Correct answer: A

Rationale: The correct first intervention for a male client with a bowel obstruction and intractable vomiting is to infuse 0.9% sodium chloride 500 ml bolus. This intervention is crucial to address the risk of hypovolemia due to excessive vomiting. Administering intravenous fluids will help prevent dehydration, maintain blood pressure, and stabilize the client's condition. Choice B, administering an antiemetic intravenously, may not be effective as the client has already been unresponsive to antiemetics orally. Choice C, inserting a nasogastric tube, may be necessary but is not the priority in this situation. Choice D, preparing the client for surgery, should only be considered after stabilizing the client's fluid and electrolyte balance.

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