Nursing Elites

1. A client scheduled for the surgical creation of an ileal conduit expresses anxiety and asks about having a drainage tube. How should the nurse respond?

• A. I will ask the provider to prescribe you an antianxiety medication.
• B. Would you like to discuss the procedure with your doctor once more?
• C. I think it would be nice to not have to worry about finding a bathroom.
• D. Would you like to speak with someone who has an ileal conduit?

Correct answer: D

Rationale: The most appropriate response for the nurse is to offer the client the opportunity to speak with someone who has undergone the same procedure. This allows the client to gain insight, ask questions, and share concerns with someone who has firsthand experience, which can help alleviate anxiety and promote a positive self-image. Seeking an antianxiety medication does not address the client's emotional concerns or promote a positive attitude towards the procedure. Discussing the procedure with the doctor again may provide more information but may not offer the same level of emotional support and understanding as speaking with someone who has lived through the experience. Commenting on the convenience of not having to search for a bathroom minimizes the client's anxiety and overlooks the emotional aspect of the client's concerns.

2. A client who has just undergone bronchoscopy was returned to the nursing unit 1 hour ago. With which assessment finding is the nurse most concerned?

• A. Oxygen saturation of 97%
• B. Equal breath sounds in both lungs
• C. Absence of cough and gag reflexes
• D. Respiratory rate of 20 breaths/min

Correct answer: C

Rationale: The correct answer is C. The absence of cough and gag reflexes is the most concerning finding for the nurse because it indicates a lack of protective airway reflexes, putting the client at risk of aspiration. Oxygen saturation of 97% is within the normal range and indicates adequate oxygenation. Equal breath sounds in both lungs are a positive finding, indicating no significant abnormalities. A respiratory rate of 20 breaths/min is also within the normal range and does not raise immediate concerns. Therefore, the absence of cough and gag reflexes poses the highest risk to the client's airway safety.

3. A client with type 1 diabetes mellitus has a blood glucose level of 620 mg/dL. After the nurse calls the physician to report the finding and monitors the client closely for:

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

Correct answer: A

Rationale: In the scenario described, a client with a blood glucose level of 620 mg/dL and type 1 diabetes mellitus is at risk of developing metabolic acidosis. In type 1 diabetes, the lack of sufficient circulating insulin leads to an increase in blood glucose levels. As the body cells utilize all available glucose, the breakdown of fats for energy results in the production of ketones, leading to metabolic acidosis. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis are not typically associated with uncontrolled type 1 diabetes. Metabolic alkalosis is more commonly linked to conditions such as vomiting or excessive diuretic use, while respiratory acidosis and respiratory alkalosis are related to respiratory system imbalances in carbon dioxide levels.

4. Which of the following is a common complication of hypertension?

• A. Diabetes.
• B. Heart failure.
• C. Kidney failure.
• D. Stroke.

Correct answer: D

Rationale: The correct answer is D: Stroke. Hypertension can lead to stroke due to the increased pressure on blood vessels in the brain, which can result in reduced blood flow and oxygen to the brain tissue. While choices B (Heart failure) and C (Kidney failure) can be complications of hypertension, they are not as directly associated as stroke. Choice A, Diabetes, is not a direct complication of hypertension but rather a separate condition that can be influenced by various factors. However, stroke is more commonly linked to the increased pressure on blood vessels in the brain in individuals with hypertension.

5. A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:

• A. Increase the frequency of self-monitoring (blood glucose testing).
• B. Reduce food intake to alleviate nausea.
• C. Discontinue the insulin dose if unable to eat.
• D. Take the normal dose of insulin.

Correct answer: A

Rationale: During illness, individuals with type 1 diabetes mellitus may experience increased insulin requirements due to factors such as stress and the release of counterregulatory hormones. Increasing the frequency of self-monitoring, as stated in choice A, is crucial to closely monitor and adjust insulin doses as needed. Choice B, reducing food intake to alleviate nausea, is incorrect as it may lead to hypoglycemia and does not address the increased insulin needs during illness. Choice C, discontinuing the insulin dose if unable to eat, is dangerous as it can result in uncontrolled hyperglycemia. Choice D, taking the normal dose of insulin, may not be sufficient during illness when insulin requirements are likely elevated.

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