Nursing Elites

1. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which 'related-to' phrase should the nurse add?

• A. Related to bone demineralization resulting in pathologic fractures
• B. Related to exhaustion secondary to an accelerated metabolic rate
• C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
• D. Related to tetany secondary to a decreased serum calcium level

Correct answer: A

Rationale: The correct answer is A: 'Related to bone demineralization resulting in pathologic fractures.' In chronic hyperparathyroidism, bone demineralization occurs due to the excessive release of parathyroid hormone, leading to increased calcium resorption from bones. This process weakens the bones, making the client prone to pathologic fractures. Choices B, C, and D are incorrect because they do not directly relate to the increased risk of injury associated with chronic hyperparathyroidism. Exhaustion, edema, dry skin, and tetany are not the primary risks for injury in this client population.

2. The nurse is caring for a client with a history of adrenal insufficiency. The nurse should monitor for which of the following signs of an Addisonian crisis?

• A. Hypertension
• B. Hyperglycemia
• C. Severe hypotension
• D. Tachycardia

Correct answer: C

Rationale: In an Addisonian crisis, there is a lack of adrenal hormones leading to severe hypotension. Hypertension (choice A) is not a typical sign of Addisonian crisis but can occur in conditions like pheochromocytoma. Hyperglycemia (choice B) is not a characteristic sign of an Addisonian crisis. Tachycardia (choice D) may occur as a compensatory mechanism in response to hypotension, but severe bradycardia is more common in an Addisonian crisis.

3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

• A. Elevated blood glucose level and a low plasma bicarbonate
• B. Decreased urine output
• C. Increased respirations and an increase in pH
• D. Comatose state

Correct answer: A

Rationale: The correct answer is A: Elevated blood glucose level and a low plasma bicarbonate. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, and metabolic acidosis, reflected by a low plasma bicarbonate. Elevated blood glucose levels are a hallmark of DKA due to the body's inability to use glucose properly. Choices B, C, and D are incorrect. Decreased urine output is not a specific finding associated with DKA. Increased respirations and an increase in pH are not typical in DKA; in fact, respiratory compensation for the metabolic acidosis in DKA leads to Kussmaul breathing (deep, rapid breathing). A comatose state may occur in severe cases of DKA but is not a confirming finding for the diagnosis.

4. Why might an RN need professional liability insurance?

• A. Protection against frivolous lawsuits without incurring expenses.
• B. Immunity from being sued by the institution if guilty of malpractice.
• C. Coverage for charges of libel, slander, assault, and HIPAA violations.
• D. Exclusively doctors face malpractice lawsuits.

Correct answer: C

Rationale: Having professional liability insurance is crucial for Registered Nurses due to various reasons. Choice A is incorrect because there are expenses associated with defending against frivolous lawsuits. Choice B is incorrect as institutions can still sue a nurse found guilty of malpractice. Choice D is incorrect because malpractice lawsuits can be filed against healthcare professionals, including nurses. Therefore, the correct answer is C, as liability policies can provide coverage for charges involving libel, slander, assault, and breaches of patient confidentiality like HIPAA violations, offering essential protection for RNs in their practice.

5. A client with type 1 DM is experiencing hypoglycemia. Which symptom should the nurse expect to observe?

• A. Tachycardia
• B. Polyuria
• C. Flushed skin
• D. Dry mouth

Correct answer: A

Rationale: The correct answer is A: Tachycardia. In hypoglycemia, the body releases adrenaline in response to low blood glucose levels, leading to symptoms such as tachycardia (rapid heart rate). Choice B, polyuria, refers to excessive urination and is not a typical symptom of hypoglycemia. Choice C, flushed skin, is not a common symptom of hypoglycemia; instead, pale skin and sweating are more characteristic. Choice D, dry mouth, is not directly associated with hypoglycemia; rather, it can be a symptom of hyperglycemia or dehydration.

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