Nursing Elites

1. A 40-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The combination of symptoms including fatigue, polyuria, polydipsia, along with laboratory findings of hyperglycemia and ketonuria strongly suggest type 1 diabetes mellitus. In type 1 diabetes mellitus, there is a deficiency of insulin leading to high blood sugar levels (hyperglycemia) and the breakdown of fats producing ketones, causing ketonuria. Type 2 diabetes mellitus typically presents differently and is more common in older individuals. Diabetes insipidus is characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone, distinct from the provided clinical scenario. Hyperthyroidism may present with some overlapping symptoms like fatigue, but it does not account for the specific laboratory findings of hyperglycemia and ketonuria seen in this case.

2. A client with severe rheumatoid arthritis is experiencing joint pain and stiffness. Which intervention should the nurse implement to help relieve the client's symptoms?

• A. Apply cold packs to the affected joints.
• B. Encourage passive range-of-motion exercises.
• C. Administer a muscle relaxant.
• D. Provide a high-calorie diet.

Correct answer: B

Rationale: Encouraging passive range-of-motion exercises is the most appropriate intervention to help relieve symptoms of joint pain and stiffness in clients with severe rheumatoid arthritis. These exercises help maintain joint mobility, prevent muscle contractures, and reduce stiffness in the affected joints. Passive range-of-motion exercises can also improve circulation to the joints, promoting healing and reducing pain. Applying cold packs may help with inflammation and pain temporarily, but it does not address the long-term joint mobility issues associated with rheumatoid arthritis. Muscle relaxants are not typically indicated for managing joint pain and stiffness in rheumatoid arthritis. While nutrition is important for overall health, providing a high-calorie diet is not a direct intervention for relieving joint pain and stiffness in this context.

3. A client with acute pancreatitis is admitted to the hospital. What is the priority nursing intervention for this client?

• A. Administering oral pancreatic enzymes
• B. Encouraging a high-protein diet
• C. Maintaining NPO status and administering IV fluids
• D. Providing a low-fat diet

Correct answer: C

Rationale: The priority nursing intervention for a client with acute pancreatitis is to maintain NPO (nothing by mouth) status and administer IV fluids. This approach helps rest the pancreas, decrease pancreatic stimulation, and prevent further exacerbation of the condition. By withholding oral intake and providing IV fluids, the pancreas is given the opportunity to recover and inflammation can be reduced. This intervention is crucial in the acute phase of pancreatitis to support the healing process and prevent complications.

4. Aspirin is prescribed for a 9-year-old child with rheumatic fever to control the inflammatory process, promote comfort, and reduce fever. What intervention is most important for the nurse to implement?

• A. Instruct the parents to hold the aspirin until the child has first had a tepid sponge bath.
• B. Administer the aspirin with at least two ounces of water or juice.
• C. Notify the healthcare provider if the child complains of ringing in the ears.
• D. Advise the parents to question the child about seeing yellow halos around objects.

Correct answer: C

Rationale: In children, ringing in the ears (tinnitus) can be a sign of aspirin toxicity. Aspirin toxicity can be particularly concerning in children and can lead to serious complications. Therefore, it is crucial for the nurse to prioritize monitoring for signs of aspirin toxicity, such as tinnitus, and promptly notify the healthcare provider if such symptoms occur.

5. When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?

• A. Use glycerin suppositories on a regular basis
• B. Limit physical activity in order to promote bowel peristalsis
• C. Consume high-residue, high-fiber foods
• D. Resist the urge to defecate until the urge becomes intense

Correct answer: C

Rationale: Consuming high-residue, high-fiber foods is essential in promoting normal bowel function and preventing constipation. These foods help add bulk to the stool, making it easier to pass and preventing constipation. Glycerin suppositories may provide short-term relief but are not a long-term solution for chronic constipation. Physical activity actually helps promote bowel peristalsis, so limiting it would not be beneficial. Delaying defecation can lead to stool hardening and worsening constipation.

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