this is the type of questions that usually give nursing students lot of trouble. it has the potential to mess up your timing. my advice for people taking the exam is to skip this question and take it at the end.
now this is my take on the question:
1) these patients all have a history of some type of chronic conditions.
2) when looking at which patient is the most stable for discharge, one must consider both the potential for complications and the length of time since admission. if one uses these criteria, the patient with pneumonia appears to be not only the most stable but almost the one with the least potential for complications. do not get fooled by the fact that this patient is presenting with a respiratory condition. he has probably received 5 days of antibiotic treatment and his airway is somewhat protected (chronic ventilator patient).
3) the patient with type 2 dm with antibiotic induced diarrhea is not as stable as it may look. first being on antibiotic means that he has an infection. we all know what infections do to diabetes control: it raises the blood glucose level significantly and it increases insulin requirements. in addition, dehydration (from diarrhea) in the setting of elevated blood glucose has the potential to send the patient into dka (diabetes ketoacidocis), which is a serious condition. this patient cannot be discharge 24 hours after admission. he needs rehydration and blood glucose control.
3) steven-johnson syndrome is a life threatening condition with high mortality that would require at a minimum a week of observation and treatment. this patient cannot be discharge on the same day that he was admitted.
4) the patient with hiv is immunosuppressed. therefore leg cellulitis raises the potential for sepsis. this patient will need longer treatment than 48 hours.
in conclusion, the correct answer is option a.