Nokea
The nurse is assessing a client with diabetes and notes that the client has a strong odor of acetone on their breath. What action should the nurse take next?
- A. Check the client’s blood glucose level.
- B. Offer the client a glass of water.
- C. Assess the client's urine for signs of infection.
- D. Administer insulin immediately.
Correct Answer: A
Rationale: The acetone odor on the breath is a sign of ketosis, which may indicate that the client’s blood glucose is elevated. Immediate blood glucose monitoring is needed.
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Headache warning signs that need prompt investigation include all of the following except:
- A. New onset after 50
- B. Aggravated or relieved by change of position
- C. Precipitated by Valsalva maneuver
- D. Headaches relieved with mild recurrent use of analgesics
Correct Answer: D
Rationale: Headaches relieved with mild, infrequent analgesic use typically don’t require urgent investigation.
Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
When interpreting a complete blood count (CBC) lab report, which of the following results describes the size of the RBCs?
- A. Hemoglobin
- B. Mean corpuscular volume (MCV)
- C. Red cell distribution width (RDW)
- D. Hematocrit
Correct Answer: B
Rationale: MCV measures the average size of red blood cells.
Which of the following findings could indicate a need for further evaluation of the cardiac patient?
- A. Hematocrit 42%
- B. Potassium 4.2 mg/dl
- C. Sodium 140 mEq/dl
- D. Low-density lipoprotein of 190 mg/dl
Correct Answer: D
Rationale: LDL levels over 160 mg/dl warrant further evaluation for cardiovascular risk.
A patient presents with an elongated head with bony prominence of the forehead, nose, and lower jaw. These facial features could be suggestive of:
- A. Nephrotic syndrome
- B. Acromegaly
- C. Cushing’s syndrome
- D. Parkinson’s disease
Correct Answer: B
Rationale: Acromegaly is characterized by enlargement of bones and soft tissues, leading to features like a prominent jaw and forehead.