Nursing Elites

1. A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which intervention should the nurse implement first?

• A. Administer intravenous calcium gluconate.
• B. Administer intravenous insulin and glucose.
• C. Administer intravenous sodium bicarbonate.
• D. Administer a loop diuretic as prescribed.

Correct answer: B

Rationale: The correct answer is to administer intravenous insulin and glucose first. This intervention helps drive potassium back into the cells, lowering serum levels effectively. Administering intravenous calcium gluconate (choice A) is used to stabilize cardiac membranes in severe hyperkalemia but does not address the underlying cause. Administering intravenous sodium bicarbonate (choice C) is used in metabolic acidosis, not hyperkalemia. Administering a loop diuretic (choice D) can help eliminate potassium but is not the first-line treatment for hyperkalemia in CKD.

2. A client with a postoperative wound that eviscerated yesterday has an elevated temperature. Which intervention is most important for the nurse to implement?

• A. Initiate contact isolation.
• B. Obtain a wound swab for culture and sensitivity.
• C. Assess temperature every 4 hours.
• D. Use alcohol-based solutions for hand hygiene.

Correct answer: B

Rationale: In this scenario, the most critical intervention is to obtain a wound swab for culture and sensitivity. This will help identify the causative organism present in the wound, enabling healthcare providers to prescribe the appropriate treatment. Initiating contact isolation (Choice A) may be necessary in certain situations but is not the priority in this case where infection is suspected. Assessing the temperature (Choice C) is important for monitoring the client's condition but does not address the underlying cause. Using alcohol-based solutions for hand hygiene (Choice D) is a standard practice for infection control but does not directly address the client's specific condition of a postoperative wound with evisceration and elevated temperature.

3. A male client with an antisocial personality disorder is admitted to an inpatient mental health unit for multiple substance dependencies. When providing a history, the client justifies to the nurse his use of illicit drugs. Based on this pattern of behavior, this client's history is most likely to include which finding?

• A. Multiple convictions for misdemeanors and class B felonies.
• B. A history of stable employment
• C. Strong relationships with family members
• D. A pattern of seeking help when needed

Correct answer: A

Rationale: The correct answer is A: Multiple convictions for misdemeanors and class B felonies. Clients with antisocial personality disorder often engage in behaviors that disregard societal rules and norms, leading to legal issues and criminal activities. This behavior is characteristic of individuals with antisocial personality disorder. Choices B, C, and D are incorrect because individuals with this disorder are less likely to have stable employment, strong family relationships, or seek help when needed due to their pattern of defiance and disregard for authority and rules.

4. A client with cirrhosis is admitted with jaundice and ascites. Which intervention should the nurse implement first?

• A. Administer a diuretic as prescribed.
• B. Administer lactulose as prescribed.
• C. Monitor the client's weight daily.
• D. Assess the client's neurological status.

Correct answer: B

Rationale: Administering lactulose is the first priority in managing a client with cirrhosis to reduce ammonia levels and prevent worsening hepatic encephalopathy. Lactulose helps in decreasing the absorption of ammonia in the intestines and promotes its excretion through the stool. This intervention is crucial in preventing the development or progression of hepatic encephalopathy. Administering a diuretic (Choice A) may be necessary to manage ascites, but it is not the priority over lactulose in this scenario. Monitoring the client's weight (Choice C) is important to assess fluid retention but is not the first intervention required. Assessing the client's neurological status (Choice D) is essential in cirrhosis, but administering lactulose takes precedence to prevent hepatic encephalopathy.

5. A client with type 2 diabetes is admitted with hyperglycemic hyperosmolar syndrome (HHS). Which clinical finding is most concerning to the nurse?

• A. Serum glucose of 500 mg/dL
• B. Blood pressure of 140/90 mmHg
• C. Serum osmolarity of 320 mOsm/kg
• D. Serum pH of 7.30

Correct answer: C

Rationale: A serum osmolarity of 320 mOsm/kg is the most concerning finding in a client with hyperglycemic hyperosmolar syndrome (HHS) as it indicates severe dehydration and hypertonicity. This high serum osmolarity level can lead to neurological complications and requires immediate intervention to prevent further deterioration. Serum glucose levels, blood pressure, and serum pH are important parameters to monitor in HHS, but a significantly elevated serum osmolarity poses a higher risk of complications and warrants urgent attention. High serum glucose levels, like 500 mg/dL, are expected in HHS but do not directly indicate the severity of dehydration. Blood pressure of 140/90 mmHg is within normal limits and may not be directly related to the acute complications of HHS. A serum pH of 7.30 suggests acidosis, which is important to address but may not be as immediately concerning as severe dehydration indicated by high serum osmolarity.

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