Nokea
A nursing student asks the nurse manager to explain the forces that drive health care reform. The appropriate response by the nurse manager should include
- A. The escalation of fees with a decreased reimbursement percentage
- B. High costs of diagnostic and end-of-life treatment procedures
- C. Increased numbers of elderly and of the chronically ill of all ages
- D. A steep rise in provider fees and in insurance premiums
Correct Answer: A
Rationale: The escalation of fees with a decreased reimbursement percentage. The percentage of the gross national product representing health care costs rose dramatically with reimbursement based on fee for service. Reimbursement for Medicare and Medicaid recipients based on fee for service also escalates health care costs.
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The nurse is performing discharge teaching for a client with Addison’s disease.
- A. What is the most important instruction for a client with Addison’s disease?
- B. Signs and symptoms of infection.
- C. Fluid and electrolyte balance.
- D. Seizure precautions.
- E. Steroid replacement.
Correct Answer: D
Rationale: Steroid replacement is critical for Addison’s disease to manage adrenal insufficiency and prevent life-threatening crises. Infection, fluid balance, and seizures are secondary concerns compared to ensuring steroid therapy adherence.
The infant of a diabetic mother has a blood glucose of 90 mg/dL and a serum calcium level of 7.0 mg/dL. The nurse should anticipate that which of the following medications would be administered IV?
- A. Insulin.
- B. Glucose.
- C. Phenobarbital.
- D. Calcium gluconate.
Correct Answer: D
Rationale: Hypocalcemia (7.0 mg/dL) in infants of diabetic mothers risks tetany; calcium gluconate is indicated. Options A, B, and C are inappropriate.
The nurse is assessing a client who may be bulimic. What objective finding indicates bulimia?
- A. Low self-esteem
- B. Loss of tooth enamel
- C. Feeling of loss of control
- D. Feeling of social inadequacy
Correct Answer: B
Rationale: Loss of tooth enamel from frequent vomiting is an objective sign of bulimia, distinguishing it from subjective emotional symptoms.
The nurse is caring for a client with heart failure.
- A. Which symptom indicates worsening heart failure in a client?
- B. Weight gain of 2 pounds in 24 hours.
- C. Decreased blood pressure.
- D. Clear lung sounds bilaterally.
- E. Improved exercise tolerance.
Correct Answer: A
Rationale: A weight gain of 2 pounds in 24 hours indicates fluid retention, a sign of worsening heart failure. Decreased blood pressure may occur but is less specific, clear lung sounds suggest stability, and improved exercise tolerance indicates improvement.
The nurse is caring for clients on the neurology unit.
- A. What is the most appropriate action for the nurse to take after noting a client suddenly developed a fixed and dilated pupil?
- B. Reassess in five minutes.
- C. Check the client’s visual acuity.
- D. Lower the head of the client’s bed.
- E. Contact the physician.
Correct Answer: D
Rationale: A fixed and dilated pupil is a neurological emergency, often indicating increased intracranial pressure or brain herniation. Immediate physician notification is critical to initiate interventions. Reassessing later delays care, checking visual acuity is irrelevant, and lowering the bed could worsen intracranial pressure.