Nursing Elites

1. A client with a history of type 1 diabetes Mellitus (DM) and asthma is readmitted to the unit for the third time in two months with a current fasting blood sugar (FBS) of 325mg/dl (18mmol/L SI). The client describes to the nurse not understanding why the blood glucose level continues to be out of control. Which interventions should the nurse implement?

• A. Have the client describe a typical day at work, home, and social activities
• B. Determine if the client is using a new insulin needle for each administration
• C. Evaluate the client's asthma medications that can elevate blood glucose
• D. Have the client demonstrate the technique used to monitor blood glucose levels

Correct answer: A

Rationale: The correct answer is to have the client describe a typical day at work, home, and social activities. By understanding the client's daily routine, the nurse can gain valuable insights into lifestyle factors that may be impacting blood glucose control. This information is essential for identifying potential triggers or patterns contributing to the elevated blood sugar levels. Option B, determining if the client is using a new insulin needle for each administration, focuses more on the technical aspect of insulin delivery and is not directly related to daily activities affecting blood glucose levels. Option C, evaluating the client's asthma medications that can elevate blood glucose, could be relevant but is not as directly linked to the client's lifestyle choices as option A. Option D, having the client demonstrate the technique for monitoring blood glucose levels, is important for assessing their skills but does not provide information on daily activities that may be influencing blood sugar levels.

2. The client with peripheral vascular disease (PVD) and a history of heart failure may have a low tolerance for exercise due to:

• A. Decreased blood flow.
• B. Increased blood flow.
• C. Decreased pain.
• D. Increased blood viscosity.

Correct answer: A

Rationale: The correct answer is A: Decreased blood flow. In clients with peripheral vascular disease (PVD) and a history of heart failure, decreased blood flow due to heart failure can result in reduced oxygen delivery to tissues. This reduced oxygen supply can lead to low exercise tolerance. Increased blood flow (Choice B) is not typically associated with reduced exercise tolerance in these clients. Decreased pain (Choice C) and increased blood viscosity (Choice D) are not the primary factors contributing to low exercise tolerance in this scenario.

3. The patient is taking low-dose erythromycin prophylactically and will start cefaclor for treating an acute infection. The nurse should discuss this with the provider because taking both medications simultaneously can cause which effect?

• A. Decreased effectiveness of cefaclor.
• B. Increased effectiveness of cefaclor.
• C. Decreased effectiveness of erythromycin.
• D. Increased effectiveness of erythromycin.

Correct answer: A

Rationale: When erythromycin and cefaclor are taken together, erythromycin can inhibit the metabolism of cefaclor, leading to elevated cefaclor levels and potentially causing adverse effects. This results in a decrease in the effectiveness of cefaclor. Therefore, the nurse should discuss this potential drug interaction with the provider to consider an alternative treatment or adjust the dosages to prevent complications. Choices B, C, and D are incorrect because the concern lies with the effect on cefaclor when combined with erythromycin, not the effect on erythromycin itself.

4. A client in the postanesthesia care unit has an as-needed prescription for ondansetron (Zofran). Which of the following occurrences would prompt the nurse to administer this medication to the client?

• A. Paralytic ileus
• B. Incisional pain
• C. Urine retention
• D. Nausea and vomiting

Correct answer: D

Rationale: The correct answer is D: Nausea and vomiting. Ondansetron is an antiemetic used to manage postoperative nausea and vomiting, as well as nausea and vomiting related to chemotherapy. It is not indicated for treating paralytic ileus, incisional pain, or urine retention. Paralytic ileus is a condition of the gastrointestinal tract characterized by the paralysis of intestinal muscles, which would not be treated with ondansetron. Incisional pain is typically managed with analgesics, not antiemetics. Urine retention is a urinary issue that does not involve nausea and vomiting, making ondansetron an inappropriate choice for this condition.

5. What is the most common cause of urinary tract infections (UTIs)?

• A. Escherichia coli infection
• B. Staphylococcus aureus infection
• C. Pseudomonas aeruginosa infection
• D. Klebsiella pneumoniae infection

Correct answer: A

Rationale: Escherichia coli is the most common cause of urinary tract infections (UTIs). It is responsible for the majority of UTIs, especially in women. E. coli is a normal inhabitant of the bowel and can enter the urinary tract through the urethra, leading to infection. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae are less common causes of UTIs compared to E. coli. Staphylococcus aureus typically causes skin and soft tissue infections, Pseudomonas aeruginosa is more commonly associated with healthcare-associated infections, and Klebsiella pneumoniae is known for causing pneumonia and other respiratory infections.

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