Nursing Elites

1. What are the signs of hypoglycemia, and how should they be managed?

• A. Sweating, trembling; administer glucose
• B. Headache, confusion; administer insulin
• C. Dizziness, fatigue; administer glucose
• D. Increased heart rate; provide a high-sugar snack

Correct answer: A

Rationale: The correct signs of hypoglycemia are sweating and trembling. These should be managed by administering glucose to raise blood sugar levels. Headache, confusion, dizziness, fatigue, or increased heart rate are not typical signs of hypoglycemia. Administering insulin in response to hypoglycemia would further lower blood sugar levels, exacerbating the condition.

2. Which nursing action is a priority when managing a client with a wound infection?

• A. Change the wound dressing every 24 hours
• B. Perform a wound culture before administering antibiotics
• C. Cleanse the wound with alcohol-based solutions
• D. Apply a wet-to-dry dressing to the wound

Correct answer: B

Rationale: Performing a wound culture before administering antibiotics is crucial when managing a client with a wound infection. This step helps identify the specific pathogens causing the infection, allowing for the prescription of the most effective antibiotics. Changing the wound dressing every 24 hours (Choice A) is important for wound care but not the priority when an infection is present. Cleansing the wound with alcohol-based solutions (Choice C) can be too harsh and may delay wound healing. Applying a wet-to-dry dressing (Choice D) is not recommended for infected wounds as it can cause trauma to the wound bed during dressing changes.

3. A client with hypertension is asking for lifestyle changes. What should the nurse recommend?

• A. Increase sodium intake to manage blood pressure
• B. Reduce caffeine and alcohol consumption
• C. Encourage the client to increase protein intake
• D. Increase intake of fruits and vegetables

Correct answer: B

Rationale: The correct answer is B: Reduce caffeine and alcohol consumption. This recommendation is crucial for managing hypertension as excessive caffeine and alcohol intake can elevate blood pressure. By reducing these stimulants, the client can help regulate their blood pressure levels. Choices A, C, and D are incorrect. Increasing sodium intake (Choice A) is contraindicated in hypertension as it can lead to fluid retention and worsen blood pressure. Encouraging increased protein intake (Choice C) and increasing intake of fruits and vegetables (Choice D) are generally healthy dietary suggestions but not specifically targeted at managing hypertension.

4. What is the role of the nurse in the care of a patient with a pressure ulcer?

• A. Clean the wound and apply a protective dressing
• B. Assess the wound and reposition the patient frequently
• C. Apply pressure to the ulcer and monitor for signs of healing
• D. Provide pain relief and administer antibiotics as needed

Correct answer: B

Rationale: The correct answer is B: Assess the wound and reposition the patient frequently. When caring for a patient with a pressure ulcer, it is crucial for the nurse to assess the wound regularly to monitor its progress and prevent complications. Additionally, repositioning the patient frequently helps to relieve pressure on the affected area, prevent further damage, and promote healing. Choice A is incorrect because while cleaning the wound is important, applying a protective dressing is not the primary role of the nurse in managing a pressure ulcer. Choice C is incorrect as applying pressure to the ulcer is harmful, and monitoring for signs of healing should not involve applying pressure. Choice D is incorrect as providing pain relief and administering antibiotics may be necessary but are not the primary interventions for managing a pressure ulcer.

5. Which of the following is an early indicator that suctioning is needed for a client with a tracheostomy?

• A. Bradycardia
• B. Hypotension
• C. Irritability
• D. Confusion

Correct answer: C

Rationale: Irritability is an early indicator that suctioning is needed for a client with a tracheostomy because it can signal discomfort or difficulty breathing due to mucus accumulation, prompting the need for suctioning to clear the airway. Bradycardia (Choice A) and hypotension (Choice B) are not typically early indicators of the need for suctioning in a client with a tracheostomy. Confusion (Choice D) is also not a direct early indicator of the need for suctioning in this context.

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