Nursing Elites

1. During a home health visit, the nurse notices that an older male client with type 2 diabetes mellitus is wearing loose cloth slippers. The client reports that he cannot comfortably wear other shoes because his toenails get in the way. The nurse inspects the client's feet and finds long thick nails that curl down under some of the toes. Which action should the nurse take?

• A. demonstrate proper foot care to the client and family
• B. have a home health aide assist the client with hygiene weekly
• C. schedule an appointment for the client with a podiatrist
• D. trim the client's toenails gradually over several visits

Correct answer: C

Rationale: Scheduling an appointment with a podiatrist is the most appropriate action in this scenario. For a client with long thick nails that curl under the toes, professional foot care by a podiatrist is necessary to prevent complications, especially in a client with diabetes mellitus. Demonstrating proper foot care (choice A) may not address the immediate need for nail trimming. Having a home health aide assist with hygiene weekly (choice B) may not be sufficient for managing the client's toenail issue effectively. Trimming the client's toenails gradually over several visits (choice D) should be performed by a professional like a podiatrist to avoid potential complications.

2. A public health nurse is planning an educational campaign to reduce the incidence of hypertension in the community. Which group should be the primary target of this campaign?

• A. adolescents
• B. young adults
• C. middle-aged adults
• D. older adults

Correct answer: C

Rationale: The correct answer is C, middle-aged adults. Middle-aged adults are at a higher risk for developing hypertension due to lifestyle factors and aging. Targeting this group for preventive measures such as dietary changes, exercise, and stress management can have a significant impact on reducing the incidence of hypertension. Choices A, B, and D are less appropriate targets as adolescents generally have lower rates of hypertension, young adults are less likely to be affected by hypertension at this stage, and older adults may already have established hypertension or comorbidities that could make prevention more challenging.

3. What information should the nurse provide a client who has undergone cryosurgery for stage 1A cervical cancer?

• A. Expect heavy, watery vaginal discharge for 3 to 6 weeks.
• B. Use a tampon instead of a sanitary napkin.
• C. Report any severe cramping immediately.
• D. Avoid sexual intercourse for 3 to 6 weeks.

Correct answer: D

Rationale: After cryosurgery for stage 1A cervical cancer, clients should avoid sexual intercourse for 3 to 6 weeks to reduce the risk of infection. Heavy, watery vaginal discharge is expected but not the focus of post-procedure instructions. Using tampons is contraindicated as they can introduce bacteria into the healing cervix. While reporting severe cramping is important, avoiding sexual intercourse is the priority to prevent complications.

4. The healthcare provider is caring for a client with a chest tube. Which observation indicates that the chest tube is functioning effectively?

• A. Continuous bubbling in the water-seal chamber.
• B. Intermittent bubbling in the suction control chamber.
• C. No fluctuation (tidaling) in the water-seal chamber.
• D. Drainage of clear, pale yellow fluid from the chest tube.

Correct answer: B

Rationale: Intermittent bubbling in the suction control chamber is the correct observation indicating effective functioning of the chest tube. This bubbling signifies that the suction system is working correctly and maintaining the desired negative pressure in the pleural space. Continuous bubbling in the water-seal chamber suggests an air leak, which is not a normal finding. No fluctuation (tidaling) in the water-seal chamber may indicate a blockage or lack of communication between the pleural space and the water-seal, which is not ideal. Drainage of clear, pale yellow fluid from the chest tube is a normal finding, but it does not specifically indicate the effectiveness of the chest tube function.

5. A client with type 2 diabetes mellitus is admitted with hyperosmolar hyperglycemic state (HHS). Which laboratory result requires immediate intervention?

• A. Serum osmolality of 320 mOsm/kg.
• B. Serum glucose of 600 mg/dL.
• C. Serum potassium of 4.5 mEq/L.
• D. Serum sodium of 140 mEq/L.

Correct answer: B

Rationale: A serum glucose level of 600 mg/dL is extremely high in a client with hyperosmolar hyperglycemic state (HHS) and poses a significant risk of serious complications such as dehydration, coma, and electrolyte imbalances. Rapid intervention is crucial to normalize the glucose level and prevent further deterioration. Serum osmolality of 320 mOsm/kg, serum potassium of 4.5 mEq/L, and serum sodium of 140 mEq/L, while important to monitor in HHS, do not represent an immediate life-threatening condition that requires urgent intervention compared to the critically high glucose level.

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