Nursing Elites

1. A client with type 1 diabetes reports blurry vision. What is the most important assessment the nurse should perform?

• A. Assess the client’s most recent blood glucose levels.
• B. Check the client’s hemoglobin A1C level.
• C. Check the client’s blood pressure for signs of hypertension.
• D. Examine the client’s feet for signs of neuropathy.

Correct answer: A

Rationale: Blurry vision in clients with type 1 diabetes may indicate hyperglycemia, which requires prompt assessment of recent blood glucose levels to determine the cause and appropriate intervention. Checking the client’s hemoglobin A1C level (Choice B) is useful for assessing long-term glucose control, not for immediate management of blurry vision. Monitoring blood pressure (Choice C) is important in diabetes care but is not the most crucial assessment when blurry vision is reported. Examining the client’s feet for signs of neuropathy (Choice D) is important in diabetic foot care but is not the priority when dealing with blurry vision.

2. A client tells the nurse about working out with a personal trainer and swimming three times a week in an effort to lose weight and sleep better. The client states that it still takes hours to fall asleep at night. Which action should the nurse implement?

• A. Advise the client to reduce exercise intensity
• B. Ask the client for a description of the exercise schedule that is being followed
• C. Encourage the client to try relaxation techniques before bed
• D. Suggest avoiding water-based exercise before bed

Correct answer: B

Rationale: Asking the client for a description of the exercise schedule being followed is the most appropriate action for the nurse to take in this scenario. Understanding the timing and intensity of the client's exercise routine can help identify if the activity is contributing to sleep disturbances. Exercise too close to bedtime can cause difficulty falling asleep. Choices A, C, and D do not directly address the need to assess the exercise schedule and may not provide the necessary information to identify the potential cause of the client's sleep issue.

3. Following discharge teaching, a male client with a duodenal ulcer tells the nurse that he will drink plenty of dairy products, such as milk, to help coat and protect his ulcer. What is the best follow-up action by the nurse?

• A. Encourage the client to drink milk
• B. Review with the client the need to avoid foods that are rich in milk and cream
• C. Instruct the client to take antacids instead
• D. Advise the client to monitor their symptoms

Correct answer: B

Rationale: The client should be advised to avoid foods rich in milk and cream. Although they provide temporary relief, dairy products, especially milk, stimulate gastric acid secretion, which can exacerbate the symptoms of a duodenal ulcer. Encouraging the client to drink milk (Choice A) would be counterproductive and could worsen the condition. Instructing the client to take antacids (Choice C) may provide symptomatic relief but does not address the root cause of the issue. Advising the client to monitor their symptoms (Choice D) is vague and does not provide specific guidance on managing the duodenal ulcer. Therefore, the best action is to review with the client the need to avoid foods rich in milk and cream to ensure proper ulcer management.

4. A client with deep vein thrombosis (DVT) is receiving heparin and reports tarry stools. What should the nurse do?

• A. Prepare to administer warfarin.
• B. Assess characteristics of the client's pain.
• C. Monitor stools for blood and review PTT results.
• D. Continue the heparin and prepare to administer Vitamin K.

Correct answer: C

Rationale: When a client on heparin reports tarry stools, it can be indicative of gastrointestinal bleeding. The correct action for the nurse is to monitor the stools for blood and review the Partial Thromboplastin Time (PTT) results. This is essential to detect any potential bleeding complications associated with heparin therapy. Option A is incorrect because warfarin is not the immediate intervention for tarry stools in a client on heparin. Option B is irrelevant to the situation described. Option D is incorrect as Vitamin K is the antidote for warfarin, not heparin.

5. A client with adrenal insufficiency is admitted to the ICU with acute adrenal crisis. The client's vital signs include heart rate 138 bpm and BP 80/60. What is the nurse's first intervention?

• A. Obtain an analgesic prescription.
• B. Administer an IV fluid bolus.
• C. Administer PRN antipyretic.
• D. Cover the client with a cooling blanket.

Correct answer: B

Rationale: The correct first intervention for a client with adrenal crisis and hypotension is to administer an IV fluid bolus. In adrenal crisis, the body is deficient in cortisol, leading to hypotension. Fluid resuscitation helps stabilize the blood pressure. Obtaining an analgesic prescription (Choice A) is not the priority in this situation. Administering a PRN antipyretic (Choice C) is not indicated as the client's vital signs do not suggest fever. Covering the client with a cooling blanket (Choice D) is not appropriate for addressing hypotension in adrenal crisis.

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