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 a history of severe rheumatoid arthritis is receiving a corticosteroid. Which assessment finding should the nurse report to the healthcare provider immediately?

• A. Blood glucose level of 180 mg/dL
• B. Weight gain of 2 pounds in 24 hours
• C. Blood pressure of 140/90 mmHg
• D. Increased joint pain

Correct answer: C

Rationale: Elevated blood pressure (140/90 mmHg) is a significant finding that the nurse should report immediately. Hypertension can be a severe side effect of corticosteroid therapy, especially in clients with preexisting conditions like rheumatoid arthritis. It requires prompt intervention to prevent complications such as cardiovascular events. The other options, while important to monitor, are not as critical as elevated blood pressure in this context. A blood glucose level of 180 mg/dL may indicate hyperglycemia, weight gain could be due to fluid retention, and increased joint pain is expected in a client with severe rheumatoid arthritis.

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

• A. White blood cell count of 10,000/mm³
• B. Hemoglobin of 12 g/dL
• C. Liver function tests
• D. Platelet count of 150,000/mm³

Correct answer: C

Rationale: The correct answer is C: Liver function tests. Methotrexate can cause hepatotoxicity, making it essential to closely monitor liver function tests in clients receiving this medication. Monitoring white blood cell count, hemoglobin, or platelet count is not specifically required for methotrexate therapy and would not provide relevant information regarding potential adverse effects of the medication.

4. A 46-year-old male client who had a myocardial infarction 24 hours ago comes to the nurse's station fully dressed and wanting to go home. He tells the nurse that he is feeling much better at this time. Based on this behavior, which nursing problem should the nurse formulate?

• A. Ineffective coping related to denial.
• B. Risk for impaired cardiac function.
• C. Noncompliance related to lack of knowledge.
• D. Anxiety related to hospitalization.

Correct answer: A

Rationale: The correct answer is A: Ineffective coping related to denial. The client's desire to leave the hospital shortly after a myocardial infarction despite the severity of the condition indicates denial and ineffective coping. This behavior could lead to complications as the client may not adequately address his health needs. Choice B, Risk for impaired cardiac function, is not the most appropriate nursing problem in this scenario as the client's behavior is more indicative of psychological coping issues rather than a direct physiological risk at this moment. Choice C, Noncompliance related to lack of knowledge, does not align with the client's behavior of wanting to leave the hospital. Choice D, Anxiety related to hospitalization, may not be the best option as the client's behavior is more suggestive of denial rather than anxiety about being hospitalized.

5. A client who is receiving long-term steroid therapy complains of blurred vision. Which intervention should the nurse implement first?

• A. Instruct the client to use artificial tears to lubricate the eyes
• B. Administer an ophthalmic antibiotic as prescribed
• C. Arrange for the client to see an optometrist for an eye exam
• D. Notify the healthcare provider immediately

Correct answer: D

Rationale: The correct answer is to notify the healthcare provider immediately (Option D). Blurred vision in a client on long-term steroid therapy can be a sign of serious conditions like cataracts or glaucoma, which need urgent medical evaluation and management. Instructing the client to use artificial tears (Option A) may help with dry eyes but does not address the underlying cause of blurred vision. Administering an ophthalmic antibiotic (Option B) is not indicated unless there is a specific infection present. Referring the client to an optometrist for an eye exam (Option C) may delay necessary medical intervention by the healthcare provider, who should be involved promptly in this situation.

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