Nursing Elites

1. A middle-aged male client with diabetes continues to eat an abundance of foods that are high in sugar and fat. According to the Health Belief Model, which event is most likely to increase the client's willingness to become compliant with the prescribed diet?

• A. He visits his diabetic brother who just had surgery to amputate an infected foot.
• B. He is provided with the most current information about the dangers of untreated diabetes.
• C. He comments on the community service announcements about preventing complications associated with diabetes.
• D. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet.

Correct answer: A

Rationale: According to the Health Belief Model, the most effective event to increase compliance with the prescribed diet for a middle-aged male client with diabetes is experiencing a significant consequence related to the disease. In this case, visiting his diabetic brother who just had surgery to amputate an infected foot would serve as a strong 'cue to action,' increasing the client's perceived seriousness of the disease. This event is likely to have a more immediate and impactful effect on the client than other options. Option B provides valuable information but may not have the same personal and emotional impact as witnessing a severe consequence firsthand. Option C involves indirect exposure to prevention messages, which might not be as compelling as a direct experience. Option D, while supportive, does not present a direct consequence of non-compliance like option A does.

2. A client with peripheral arterial disease (PAD) has cool and pale feet with diminished pulses. Which of the following interventions should the nurse implement?

• A. Keep the legs elevated above the level of the heart.
• B. Encourage the client to exercise daily.
• C. Apply warm compresses to the affected area.
• D. Apply ice packs to the affected area.

Correct answer: C

Rationale: In peripheral arterial disease (PAD), there is decreased blood flow to the extremities. Applying warm compresses helps dilate blood vessels, improve circulation, and relieve symptoms. Elevating the legs above the heart level may further compromise blood flow. Encouraging daily exercise is important in PAD management but may not be appropriate when the client has cool, pale feet with diminished pulses. Applying ice packs can worsen vasoconstriction and further reduce blood flow, exacerbating symptoms in PAD.

3. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take?

• A. Administer the medications and request an order for serum electrolytes.
• B. Give both medications and evaluate serum blood glucose frequently.
• C. Hold the digoxin and notify the provider.
• D. Hold the hydrochlorothiazide and notify the provider.

Correct answer: C

Rationale: In this scenario, the patient is experiencing symptoms of digoxin toxicity, such as blurred vision and bradycardia. When thiazide diuretics like hydrochlorothiazide are taken with digoxin, the patient is at risk of digoxin toxicity due to the potential for thiazides to cause hypokalemia. Therefore, the correct action for the nurse to take is to hold the digoxin and notify the provider. Administering the medications without addressing the potential toxicity could worsen the patient's condition. Requesting serum electrolytes (Choice A) may be necessary but holding the digoxin takes priority. Evaluating serum blood glucose (Choice B) is not relevant to the current situation. Holding hydrochlorothiazide (Choice D) is not the best option as the primary concern is the digoxin toxicity that needs to be addressed promptly.

4. Which client should the nurse recognize as most likely to experience sleep apnea?

• A. Middle-aged female who takes a diuretic nightly.
• B. Obese older male client with a short, thick neck.
• C. Adolescent female with a history of tonsillectomy.
• D. School-aged male with a history of hyperactivity disorder.

Correct answer: B

Rationale: The correct answer is B. Sleep apnea is characterized by pauses in breathing during sleep, often due to a collapsed or blocked airway. Obesity and having a short, thick neck are risk factors for sleep apnea because excess fat around the neck can obstruct the airway. Option A (middle-aged female who takes a diuretic nightly) does not present as a common risk factor for sleep apnea. Option C (adolescent female with a history of tonsillectomy) may have had tonsils removed, which could reduce the risk of sleep apnea. Option D (school-aged male with a history of hyperactivity disorder) is not directly associated with an increased risk of sleep apnea.

5. A healthcare professional reviews the blood gas results of a client in respiratory distress. The pH is 7.32, and the PCO2 is 50 mm Hg. Which of the following acid-base imbalances does the professional recognize in these findings?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: C

Rationale: In respiratory acidosis, the pH is low (<7.35) and the PCO2 is increased (>45 mm Hg). These findings indicate that the client is experiencing respiratory acidosis, a condition where there is an excess of carbon dioxide in the blood due to inadequate ventilation, commonly seen in respiratory distress. Metabolic acidosis (Choice A) is characterized by a low pH and decreased bicarbonate levels, which is not the case in this scenario. Metabolic alkalosis (Choice B) is associated with a high pH and increased bicarbonate levels. Respiratory alkalosis (Choice D) is marked by a high pH and decreased PCO2, opposite to the values presented in the blood gas results of this client.

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