Nursing Elites

1. A client with Diabetes Insipidus (DI) is being cared for by a nurse. Which data warrants the most immediate intervention by the nurse?

• A. Serum sodium of 185 mEq/L (185 mmol/L)
• B. Dry skin with poor skin turgor
• C. Apical rate of 110 beats per minute
• D. Polyuria and excessive thirst

Correct answer: A

Rationale: A serum sodium level of 185 mEq/L (185 mmol/L) is dangerously high and indicates severe dehydration, requiring immediate intervention to prevent neurological damage. The other options are not as critical as high serum sodium levels, which can lead to serious complications such as seizures, coma, and death if not promptly addressed. Dry skin with poor skin turgor and polyuria with excessive thirst are common findings in clients with Diabetes Insipidus and should be managed but do not pose an immediate threat to the client's life. An apical heart rate of 110 beats per minute may indicate tachycardia, which could be related to dehydration but is not as urgent as addressing the severe hypernatremia.

2. The patient will take a high dose of azithromycin after discharge from the hospital. Which statement by the patient indicates understanding of the teaching?

• A. I may take antacids 2 hours before taking this drug.
• B. I should take acetaminophen for fever or mild pain.
• C. I should expect diarrhea to be a common, mild side effect.
• D. I should avoid dairy products while taking this drug.

Correct answer: A

Rationale: The correct answer is A. Azithromycin peak levels may be reduced by antacids when taken at the same time, so patients should be cautioned to take antacids 2 hours before or 2 hours after taking the drug. Choice B is incorrect because high-dose azithromycin carries a risk for hepatotoxicity when taken with other potentially hepatotoxic drugs such as acetaminophen. Choice C is incorrect as diarrhea may indicate pseudomembranous colitis and should be reported, not expected as a common mild side effect. Choice D is incorrect; there is no restriction for dairy products while taking azithromycin.

3. A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: D

Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.

4. A client who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement?

• A. Administer 20 mEq of potassium chloride.
• B. Initiate continuous cardiac monitoring.
• C. Arrange a consultation with the dietitian.
• D. Educate about the side effects of diuretics.

Correct answer: B

Rationale: Hypokalemia, defined as a serum potassium level below the normal range of 3.5 to 5 mEq/L, can lead to changes in myocardial irritability and ECG waveform, potentially causing life-threatening dysrhythmias. Therefore, the priority action for the nurse is to initiate continuous cardiac monitoring to promptly detect any abnormal heart rhythms or ventricular ectopy. This monitoring is crucial for assessing the impact of potassium replacement therapy on the cardiac rhythm and ensuring the safety of the client. While administering potassium chloride is important for correcting the hypokalemia, it should occur after cardiac monitoring is in place. Consulting with a dietitian and educating about diuretic side effects are relevant aspects of care but are not the immediate priority in this situation where cardiac monitoring takes precedence for timely intervention.

5. A client is brought to the emergency department by a neighbor. The client is lethargic and has a fruity odor on the breath. The client’s arterial blood gas (ABG) results are pH 7.25, PCO2 34 mm Hg, PO2 86 mm Hg, HCO3 14 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

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

Correct answer: A

Rationale: The correct answer is 'Metabolic acidosis.' Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (HCO3 <22 mEq/L). In this case, the client's ABG results show a pH of 7.25 and an HCO3 level of 14 mEq/L, indicating metabolic acidosis. The PCO2 of 34 mm Hg is normal, ruling out respiratory acidosis or alkalosis. The PO2 of 86 mm Hg is also within the normal range and is not indicative of a respiratory problem. Therefore, the client is experiencing metabolic acidosis based on the ABG results provided.

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