Nursing Elites

1. Your client has a doctor's order that reads 'advance diet as tolerated'. This client has returned from the recovery room after an appendectomy and he states, 'I am hungry'. What would you offer this client to consume?

• A. Cheese and crackers
• B. Apple sauce
• C. Chicken broth
• D. A peanut butter sandwich

Correct answer: C

Rationale: Chicken broth is a suitable option for a post-appendectomy patient beginning to tolerate oral intake. It is clear liquid and easily digestible, making it a gentle choice for someone who has just returned from surgery. Cheese and crackers, apple sauce, and a peanut butter sandwich are not ideal options for an individual who needs to start with a light and easily digestible diet.

2. A nurse in a prenatal clinic is caring for a group of clients. Which of the following clients should the nurse recommend for further evaluation and possible intervention?

• A. A client who is at 28 weeks gestation and has a negative Coombs titer
• B. A client who is 39 weeks of gestation and has a negative contraction stress test
• C. A client who is at 35 weeks of gestation and has a biophysical profile of 6
• D. A client who is at 37 weeks of gestation and has an L/S ratio of 2:1

Correct answer: C

Rationale: A biophysical profile of 6 at 35 weeks of gestation indicates a need for further evaluation and possible intervention. A negative Coombs titer at 28 weeks gestation (Choice A) is within normal limits. A negative contraction stress test at 39 weeks gestation (Choice B) is expected as the pregnancy nears term. An L/S ratio of 2:1 at 37 weeks of gestation (Choice D) is consistent with fetal lung maturity.

3. A client with DM has an above-knee amputation because of severe peripheral vascular disease. Two days following surgery, when preparing the client for dinner, what is the nurse's primary responsibility?

• A. Check the client's serum glucose level
• B. Assist the client out of bed to the chair
• C. Place the client in a high-Fowler's position
• D. Ensure that the client's residual limb is elevated

Correct answer: A

Rationale: The correct answer is to check the client's serum glucose level. In a client with diabetes who just had surgery, monitoring the serum glucose level is crucial to ensure proper management of the condition. This helps in preventing complications related to blood sugar fluctuations. Assisting the client out of bed may be important but not the primary responsibility at this time. Placing the client in a high-Fowler's position or ensuring the residual limb is elevated are important interventions for comfort and circulation but are not the primary concern in this scenario.

4. Which insulin has the most rapid onset of action?

• A. Lente
• B. Lispro
• C. Ultralente
• D. Humulin N

Correct answer: B

Rationale: Lispro insulin has the most rapid onset of action among the options provided. It is a rapid-acting insulin analog that is designed to control postprandial hyperglycemia effectively. Lente insulin (Choice A) and Ultralente insulin (Choice C) are intermediate-acting insulins, which have a slower onset of action compared to Lispro. Humulin N (Choice D) is a neutral protamine Hagedorn (NPH) insulin, which is an intermediate-acting insulin, not rapid-acting like Lispro. Therefore, the correct choice is Lispro.

5. Select the stage of shock that is accurately paired with its characteristic.

• A. The initial stage of shock: Hyperventilation occurs and the blood pH rises.
• B. The compensatory stage of shock: Hypoxia occurs and lactic acid rises.
• C. The progressive stage of shock: Histamine is released; fluid and proteins leak into surrounding tissues and the blood thickens.
• D. The refractory stage of shock: Potassium ions leak out; sodium ions build up, and metabolic acidosis increases.

Correct answer: C

Rationale: The progressive stage of shock is accurately described as the stage where histamine is released, leading to fluid and proteins leaking into surrounding tissues and the blood thickening. In this stage, the body's compensatory mechanisms are overwhelmed, resulting in a cascade of events that worsen the shock state. Choice A is incorrect as hyperventilation and a rise in blood pH are more characteristic of the compensatory stage. Choice B is incorrect as hypoxia and a rise in lactic acid are more typical of the progressive stage. Choice D is incorrect as the described electrolyte imbalances and metabolic acidosis are more aligned with the refractory stage of shock.

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