Nursing Elites

1. A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for excess fluid volume?

• A. The client taking diuretics
• B. The client with renal failure
• C. The client with an ileostomy
• D. The client who requires gastrointestinal suctioning

Correct answer: B

Rationale: The correct answer is B. Clients with renal failure are unable to excrete fluids effectively, leading to an increased risk of fluid volume excess. Option A, the client taking diuretics, would be at risk for fluid volume deficit due to increased urine output caused by the diuretics. Option C, the client with an ileostomy, is at risk for fluid volume deficit due to increased output from the ileostomy. Option D, the client who requires gastrointestinal suctioning, may be at risk for dehydration, but not specifically excess fluid volume.

2. 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.

3. A nurse is preparing to administer NPH insulin to a client with DM. The nurse notes that the NPH insulin vial is cloudy. The nurse should:

• A. Obtain a new vial of NPH insulin.
• B. Draw up the cloudy insulin as ordered.
• C. Shake the vial vigorously before drawing up the insulin.
• D. Warm the insulin to room temperature before administration.

Correct answer: B

Rationale: The correct answer is to draw up the cloudy insulin as ordered. NPH insulin is inherently cloudy due to its suspension of insulin crystals. Shaking the vial vigorously can lead to denaturation of the insulin molecules, altering its efficacy. Warming NPH insulin is not necessary as it can cause breakdown of insulin molecules. The nurse should gently roll the vial between hands to mix it before drawing it up to ensure an even distribution of insulin in the suspension.

4. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse the hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

• A. Phentolamine (Regitine)
• B. Methyldopa (Aldomet)
• C. Mannitol (Osmitrol)
• D. Felodipine (Plendil)

Correct answer: A

Rationale: In a hypertensive crisis due to pheochromocytoma, the appropriate medication to administer is Phentolamine (Regitine), an alpha-adrenergic blocker. Phentolamine acts quickly to block the effects of excess catecholamines that are released in pheochromocytoma, helping to rapidly lower blood pressure. Methyldopa (Aldomet) is an alpha-2 adrenergic agonist used for chronic hypertension, not for acute crises like pheochromocytoma. Mannitol (Osmitrol) is an osmotic diuretic used to reduce intracranial pressure and treat cerebral edema, not indicated for hypertensive crises. Felodipine (Plendil) is a calcium channel blocker used for chronic management of hypertension, not for acute hypertensive crises like those seen in pheochromocytoma.

5. When instructing the female client diagnosed with hyperparathyroidism about diet, Nurse Gina should stress the importance of which of the following?

• A. Restricting fluids
• B. Restricting sodium
• C. Forcing fluids
• D. Restricting potassium

Correct answer: C

Rationale: The correct answer is C: Forcing fluids. Nurse Gina should stress the importance of forcing fluids to help prevent kidney stones and hypercalcemia in clients with hyperparathyroidism. Restricting fluids (choice A) is not recommended as dehydration can worsen the condition. Restricting sodium (choice B) is not directly related to the management of hyperparathyroidism. Restricting potassium (choice D) is not typically necessary in hyperparathyroidism unless hyperkalemia is present.

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