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Which of the following interventions would be most effective in preventing the development of acute respiratory distress syndrome (ARDS)?
- A. Teaching cigarette smoking cessation.
- B. Maintaining adequate serum potassium levels.
- C. Monitoring clients for signs of hypercapnia.
- D. Replacing fluids adequately during hypovolemic states.
Correct Answer: D
Rationale: Adequate fluid replacement in hypovolemia prevents shock, a major ARDS trigger. Smoking cessation, potassium levels, and hypercapnia monitoring are less directly related to ARDS prevention.
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The client with type 1 diabetes mellitus is taught to take NPH insulin at 5 p.m. each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?
- A. 11 a.m., shortly before lunch.
- B. 1 p.m., shortly after lunch.
- C. 6 p.m., shortly after dinner.
- D. 1 a.m., while sleeping.
Correct Answer: D
Rationale: NPH insulin peaks 4–12 hours after administration (around 9 p.m. to 5 a.m.), with the greatest hypoglycemia risk overnight, such as at 1 a.m.
The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on his leg. What is the nurse's best action?
- A. Document the prednisone with current medications.
- B. Notify the surgeon of the poison ivy.
- C. Notify the anesthesiologist of the prednisone administration.
- D. Send the client to surgery.
Correct Answer: C
Rationale: Prednisone use affects adrenal function and stress response, increasing risks during anesthesia. Notifying the anesthesiologist ensures proper perioperative management, such as stress-dose steroids.
The nurse is performing a physical assessment on a client. To assess the client's visual acuity, the nurse would use a
- A. Snellen chart.
- B. tonometer device.
- C. penlight.
- D. slit lamp.
Correct Answer: A
Rationale: The Snellen chart is used to assess visual acuity by testing distance vision. A tonometer measures intraocular pressure, a penlight examines pupil response, and a slit lamp evaluates eye structures.
The nurse is discussing ocular disorders with a group of nursing students. Which of the following statements would be correct for the nurse to make? Select all that apply.
- A. Cataracts are caused by increased ocular pressure (IOP).
- B. Graves' disease may cause exophthalmos.
- C. Macular degeneration is manifested by loss of peripheral vision.
- D. Angle-closure glaucoma is manifested by headache and eye pain.
- E. Hyphema results in increased aqueous humor in the anterior chamber.
Correct Answer: B,D
Rationale: Graves' disease can cause exophthalmos (bulging eyes) due to autoimmune inflammation. Angle-closure glaucoma presents with headache and eye pain due to sudden increases in intraocular pressure. Cataracts are caused by lens opacity, not IOP. Macular degeneration affects central vision, not peripheral. Hyphema is blood in the anterior chamber, not increased aqueous humor.
The nurse is caring for an older adult in the emergency department with moderate hypothermia. Which of the following actions should the nurse take? Select all that apply.
- A. Apply external heat with a heating blanket to the client's trunk.
- B. Actively rewarm the extremities first, followed by the client's trunk.
- C. Use extracorporeal rewarming methods such as cardiopulmonary bypass or hemodialysis.
- D. Monitor for fluid, electrolyte, and metabolic abnormalities.
- E. Administer ordered medications at spaced longer intervals.
- F. Administer room temperature intravenous (IV) fluids for core rewarming.
Correct Answer: A,D,F
Rationale: Applying heat to the trunk (A), monitoring electrolytes (D), and using room-temperature IV fluids (F) are appropriate for moderate hypothermia. Rewarming extremities first (B) risks core afterdrop, extracorporeal methods (C) are for severe cases, and altering medication intervals (E) lacks evidence.