Nursing Elites

1. An elderly client is admitted with a diagnosis of bacterial pneumonia. The nurse's assessment of the client will most likely reveal which sign/symptom?

• A. Leukocytosis and febrile.
• B. Polycythemia and crackles.
• C. Pharyngitis and sputum production.
• D. Confusion and tachycardia.

Correct answer: D

Rationale: The onset of pneumonia in the elderly may be signaled by general deterioration, confusion, increased heart rate or increased respiratory rate due to the decreased oxygen- carbon dioxide exchange at the alveoli, known as the V-Q mismatch.

2. What is the correct procedure for performing an ophthalmoscopic examination on a client's right retina?

• A. Instruct the client to focus on a distant object behind the examiner and not move their eyes during the exam.
• B. Set the ophthalmoscope on the plus 2 to 3 lens and hold it in front of the examiner's right eye.
• C. From a distance of 12 to 15 inches and slightly to the side, shine the light into the client's pupil.
• D. For optimal visualization, keep the ophthalmoscope at least 3 inches from the client's eye.

Correct answer: C

Rationale: During an ophthalmoscopic examination, the client should focus on a distant object behind the examiner to dilate the pupil, and the examiner should stand at a distance of 12-15 inches away and slightly to the side. This angle allows for better visualization of the retina. Holding the ophthalmoscope firmly against the examiner's face and shining the light into the client's pupil helps examine the retina effectively. Choice A is incorrect because the client should look at a distant object, not the examiner's nose. Choice B is incorrect as the ophthalmoscope should be directed towards the client's eye, not the examiner's eye. Choice D is incorrect because keeping the ophthalmoscope at least 3 inches away may not provide an optimal view of the retina.

3. A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)?

• A. Complete blood count with differential
• B. Throat culture
• C. Urinalysis
• D. Coagulation studies

Correct answer: A

Rationale: When a patient taking trimethoprim-sulfamethoxazole (TMP-SMX) for a urinary tract infection presents with a sore throat, the nurse should request a complete blood count with differential. TMP-SMX can cause life-threatening adverse effects such as agranulocytosis, a condition characterized by a low white blood cell count, which can manifest as a sore throat. Ordering a complete blood count with differential helps assess the patient's white blood cell count to detect any potential serious adverse effects. Throat culture (Choice B) is not indicated unless there are specific signs of a throat infection. Urinalysis (Choice C) is not relevant for assessing a sore throat. Coagulation studies (Choice D) are not typically indicated for a sore throat symptom.

4. A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first?

• A. Contact the provider and recommend discontinuing the metformin.
• B. Keep the client NPO for at least 6 hours prior to the examination.
• C. Check the client’s capillary artery blood glucose and administer prescribed insulin.
• D. Administer intravenous fluids to dilute and increase the excretion of dye.

Correct answer: A

Rationale: Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The client’s health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the client’s blood glucose, and administering intravenous fluids should be part of the client’s plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.

5. A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:

• A. Increase the frequency of self-monitoring (blood glucose testing).
• B. Reduce food intake to alleviate nausea.
• C. Discontinue the insulin dose if unable to eat.
• D. Take the normal dose of insulin.

Correct answer: A

Rationale: During illness, individuals with type 1 diabetes mellitus may experience increased insulin requirements due to factors such as stress and the release of counterregulatory hormones. Increasing the frequency of self-monitoring, as stated in choice A, is crucial to closely monitor and adjust insulin doses as needed. Choice B, reducing food intake to alleviate nausea, is incorrect as it may lead to hypoglycemia and does not address the increased insulin needs during illness. Choice C, discontinuing the insulin dose if unable to eat, is dangerous as it can result in uncontrolled hyperglycemia. Choice D, taking the normal dose of insulin, may not be sufficient during illness when insulin requirements are likely elevated.

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