Nursing Elites

1. A nurse is assessing a client who has meningitis. Which of the following findings should the nurse report to the provider immediately?

• A. Generalized rash over trunk
• B. Increased temperature
• C. Decreased level of consciousness
• D. Report of photophobia

Correct answer: C

Rationale: The correct answer is C: Decreased level of consciousness. In a client with meningitis, a decreased level of consciousness is a critical finding that should be reported immediately. This could indicate increased intracranial pressure or neurological deterioration, requiring prompt intervention. Choices A, B, and D are important in the assessment of meningitis but are not as immediately concerning as a decreased level of consciousness. A generalized rash over the trunk can be seen in meningococcal meningitis, an increased temperature is expected due to the inflammatory response, and photophobia is a common symptom due to meningeal irritation.

2. A client with type 1 DM has a finger stick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

• A. Call the physician
• B. Encourage the intake of fluids
• C. Administer the insulin as ordered
• D. Give the client ½ cup of orange juice

Correct answer: C

Rationale: In this scenario, the client with type 1 DM has a high glucose level at bedtime. The appropriate action for the nurse is to administer the sliding scale insulin as ordered. This insulin regimen is specifically designed to manage high blood glucose levels. Calling the physician is not necessary as the protocol for sliding scale insulin is already in place. Encouraging fluid intake or providing orange juice is not the correct intervention for addressing high blood glucose levels in this case.

3. A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why he can't just take pills instead. What is the best response by the nurse?

• A. Insulin must be injected because it needs to work quickly.
• B. Insulin can't be in a pill because it is destroyed in stomach acid.
• C. Have you talked to your doctor about taking pills instead?
• D. I know it is tough, but you will get used to the shots soon.

Correct answer: B

Rationale: The correct answer is B because insulin cannot be taken orally as it gets destroyed by stomach acid. Choice A is incorrect as the speed of action is not the reason why insulin can't be in pill form. Choice C is incorrect as it doesn't address the nature of insulin. Choice D is incorrect as it doesn't provide a factual reason why insulin can't be in pill form.

4. A nurse in the emergency department is performing triage for a group of clients who were in a train crash. Which of the following clients should the nurse tag as emergent?

• A. A client who has an open fracture of the femur
• B. A client who has periorbital ecchymosis
• C. A client who has asymmetrical thorax
• D. A client who has a deep-partial thickness burn on the lower extremities

Correct answer: C

Rationale: In a triage situation, an asymmetrical thorax suggests a potentially life-threatening condition such as a pneumothorax or hemothorax, requiring immediate attention. This client should be tagged as emergent. Periorbital ecchymosis and deep-partial thickness burns, while concerning, may not indicate an immediate life-threatening situation. An open fracture of the femur, although serious, can be prioritized after addressing emergent cases.

5. A client with diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to:

• A. Take insulin at 2:00 PM each day
• B. Engage in physical activity daily
• C. Increase the dose of regular insulin
• D. Eat a protein and carbohydrate snack at bedtime

Correct answer: D

Rationale: Somogyi effect, also known as rebound hyperglycemia, occurs as a response to nighttime hypoglycemia. Eating a protein and carbohydrate snack at bedtime can help prevent this by stabilizing blood sugar levels throughout the night. Instructing the client to take insulin at 2:00 PM each day (Choice A) may not directly address the nighttime hypoglycemia concern. Engaging in physical activity daily (Choice B) is generally beneficial for diabetes management but may not specifically prevent Somogyi's effect. Increasing the dose of regular insulin (Choice C) without addressing the nighttime hypoglycemia issue can exacerbate the problem.

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