Nursing Elites

1. A young adult male is admitted to the emergency department with diabetic ketoacidosis (DKA). His pH is 7.25, HCO3 is 12 mEq/L, and blood glucose is 310 mg/dl. Which action should the nurse implement?

• A. Infuse sodium chloride 0.9% (normal saline)
• B. Prepare an emergency dose of glucagon
• C. Determine the last time the client ate
• D. Check urine for ketone bodies with a dipstick

Correct answer: A

Rationale: In DKA, restoring fluid balance with sodium chloride is a priority to address the dehydration and electrolyte imbalances present in this condition. Choice B, preparing an emergency dose of glucagon, is incorrect because DKA is characterized by insulin deficiency, not glucagon deficiency. Choice C, determining the last time the client ate, is not the immediate priority in managing DKA. Choice D, checking urine for ketone bodies with a dipstick, may help confirm the diagnosis of DKA but is not the most critical intervention at this time.

2. A client with end-stage renal disease (ESRD is scheduled for hemodialysis. Which laboratory value should the nurse monitor closely before the procedure?

• A. Serum creatinine
• B. Serum potassium
• C. Serum sodium
• D. Hemoglobin

Correct answer: B

Rationale: Before hemodialysis in a client with end-stage renal disease (ESRD), monitoring serum potassium closely is crucial. ESRD patients are at risk of hyperkalemia, which can lead to severe cardiac complications. Checking serum potassium levels helps in assessing and managing this electrolyte imbalance. Serum creatinine (Choice A) is a marker of kidney function but is not the most critical value to monitor before hemodialysis. Serum sodium (Choice C) may be affected in renal disease, but potassium is a more crucial electrolyte to monitor. Hemoglobin (Choice D) is essential for assessing anemia in ESRD but is not the primary focus before hemodialysis.

3. A client with a history of rheumatoid arthritis is prescribed methotrexate. Which laboratory value should the nurse monitor closely?

• A. Liver function tests
• B. Complete blood count
• C. Serum creatinine
• D. Prothrombin time

Correct answer: C

Rationale: Serum creatinine should be closely monitored in a client receiving methotrexate, as the medication can cause nephrotoxicity. Monitoring serum creatinine levels helps assess kidney function and detect potential nephrotoxic effects of methotrexate. Liver function tests (Choice A) are important to monitor for hepatotoxicity caused by methotrexate. While methotrexate can cause bone marrow suppression, leading to anemia, leukopenia, and thrombocytopenia, monitoring a complete blood count (Choice B) is essential but not the priority in this case. Prothrombin time (Choice D) is not typically affected by methotrexate therapy and is not the primary laboratory value to monitor in this situation.

4. A client with newly diagnosed peptic ulcer disease is being taught about lifestyle modifications. Which client statement indicates that further teaching is needed?

• A. ‘I should avoid eating spicy foods to prevent irritation of my ulcer.’
• B. ‘I should take my antacids regularly, even if I don’t have symptoms.’
• C. ‘I should avoid smoking to prevent exacerbation of my symptoms.’
• D. ‘I should avoid drinking alcohol to prevent irritation of my ulcer.’

Correct answer: D

Rationale: The corrected question assesses the client's understanding of lifestyle modifications for peptic ulcer disease. Choice D, 'I should avoid drinking alcohol to prevent irritation of my ulcer,' is the correct answer. This statement demonstrates that the client has a good grasp of the teaching provided, as alcohol can indeed irritate peptic ulcers. Choices A, B, and C are all accurate statements that reflect appropriate understanding of managing peptic ulcer disease and do not indicate a need for further teaching.

5. When organizing home visits for the day, which older client should the home health nurse plan to visit first?

• A. A woman who takes naproxen (Naprosyn) and reports a recent onset of dark, tarry stools.
• B. A man who receives weekly injections of epoetin (Procrit) for a low serum iron level.
• C. A man with emphysema who smokes and is complaining of white patches in his mouth.
• D. A frail woman with heart failure who reported a 2-pound weight gain in the last week.

Correct answer: A

Rationale: The correct answer is A. Dark, tarry stools may indicate gastrointestinal bleeding, a potentially life-threatening condition that requires immediate attention. Visiting this client first is crucial for prompt assessment and intervention. Choices B, C, and D do not present immediate life-threatening conditions that require urgent attention compared to the potential emergency indicated by dark, tarry stools.

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