Correct Answer: B

Rationale: The nurse should first administer IV fluids when a client with a respiratory infection shows signs of sepsis. This is because sepsis can lead to severe dehydration and hypotension, and prompt fluid resuscitation is essential to stabilize the client's hemodynamic status. Administering antibiotics (choice A) is important but addressing fluid resuscitation takes precedence. Administering pain medication (choice C) may provide comfort but does not address the underlying issue of sepsis. Providing mechanical ventilation (choice D) may be necessary in severe cases but should be considered after addressing fluid resuscitation.

Correct Answer: D

Rationale: The correct answer is D. The nursing process consists of Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation. Assessment involves gathering data about the patient's health status. Diagnosis is the identification of the patient's health problems. Outcome Identification sets goals for resolving these problems. Planning involves developing a care plan. Implementation is the execution of the care plan. Evaluation assesses the effectiveness of the care provided. Choices A, B, and C are incorrect: A: Treatment and client outcome are not individual phases in the nursing process. B: Admission and discharge planning are not standalone phases in the nursing process. C: Expected outcome is not a phase, and assessment is missing from the sequence.

Correct Answer: A

Rationale: The correct answer is A: Administer pain relief. This is the priority nursing action for a client with an electrical burn because pain management is crucial in providing comfort and reducing distress. Pain relief helps the client to relax, promotes healing, and aids in overall recovery. Administering pain relief should be the first step to ensure the client's well-being. Summary: - B: Administering oxygen may be necessary for respiratory support in some cases but is not the priority over pain relief. - C: Applying sterile dressings is important for wound care but should come after addressing pain. - D: Administering beta blockers is not indicated as the priority action for an electrical burn.

Correct Answer: C

Rationale: The correct intervention for hyperkalemia is to administer insulin (Choice C). Insulin drives potassium into cells, lowering serum potassium levels. This is effective in acutely reducing high potassium levels. Administering calcium gluconate (Choice A) is used for stabilizing cardiac membranes in hyperkalemia but does not lower potassium levels. Sodium bicarbonate (Choice B) is used for metabolic acidosis, not hyperkalemia. Furosemide (Choice D) is a loop diuretic that can lead to potassium loss but is not the primary intervention for hyperkalemia.

Correct Answer: D

Rationale: The correct answer is D because an episodic history is most appropriate for acute, short-term conditions like cold and flu symptoms seen in an outpatient clinic. This type of history focuses on the current problem and recent events leading up to it. Choice A involves a long-term care facility, which would require a more comprehensive history. Choice B describes a sudden severe symptom, which would prompt an urgent or emergent history. Choice C involves an upcoming surgical procedure, which would require a preoperative history. Therefore, option D is the most appropriate for an episodic history as it aligns with the acute nature of the condition and the focus on the current issue.