Nursing Elites

1. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

• A. Elevated blood glucose level and a low plasma bicarbonate
• B. Decreased urine output
• C. Increased respirations and an increase in pH
• D. Comatose state

Correct answer: A

Rationale: The correct answer is A: Elevated blood glucose level and a low plasma bicarbonate. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, and metabolic acidosis, reflected by a low plasma bicarbonate. Elevated blood glucose levels are a hallmark of DKA due to the body's inability to use glucose properly. Choices B, C, and D are incorrect. Decreased urine output is not a specific finding associated with DKA. Increased respirations and an increase in pH are not typical in DKA; in fact, respiratory compensation for the metabolic acidosis in DKA leads to Kussmaul breathing (deep, rapid breathing). A comatose state may occur in severe cases of DKA but is not a confirming finding for the diagnosis.

2. A client with diabetes mellitus is being educated on the importance of foot care. Which of the following instructions should the nurse include?

• A. Soak your feet daily to maintain cleanliness.
• B. Wear tight-fitting shoes to protect your feet.
• C. Apply lotion between your toes to prevent dryness.
• D. Inspect your feet daily for any cuts or sores.

Correct answer: D

Rationale: The correct answer is to instruct the client to inspect their feet daily for any cuts or sores. This is crucial for individuals with diabetes as they are at a higher risk of developing foot problems. Soaking feet daily can lead to skin breakdown and infections, making choice A incorrect. Tight-fitting shoes can cause pressure points and increase the risk of foot injuries, so choice B is incorrect. Applying lotion between the toes can create a moist environment, increasing the risk of fungal infections, making choice C incorrect.

3. The nurse is teaching a client with newly diagnosed hyperthyroidism about the management of the condition. Which of the following statements by the client indicates a need for further teaching?

• A. I should take my medication every day as prescribed.
• B. I need to avoid foods high in iodine.
• C. I can skip my medication on days when I feel fine.
• D. I should monitor my pulse regularly.

Correct answer: C

Rationale: Clients with hyperthyroidism should take their medication consistently and not skip doses, even if they feel well.

4. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

• A. Tetany
• B. Hemorrhage
• C. Thyroid storm
• D. Laryngeal nerve damage

Correct answer: A

Rationale: The correct answer is 'Tetany.' Tetany is characterized by muscle twitching, tingling, and numbness, which are indicative of hypocalcemia. After a thyroidectomy, accidental removal or damage to the parathyroid glands can lead to decreased calcium levels, resulting in tetany. Choice B, 'Hemorrhage,' is incorrect as it typically presents with symptoms such as sudden swelling, increased pain, or drop in blood pressure. Choice C, 'Thyroid storm,' is incorrect as it involves a sudden exacerbation of hyperthyroidism, leading to symptoms like fever, tachycardia, and confusion. Choice D, 'Laryngeal nerve damage,' is incorrect as it would manifest with voice changes, difficulty swallowing, or respiratory distress, not the symptoms described in the scenario.

5. A client with hyperthyroidism is prescribed methimazole. The nurse should instruct the client that the purpose of this medication is to:

• A. Decrease thyroid hormone production
• B. Increase thyroid hormone production
• C. Suppress the immune system
• D. Prevent thyroid storm

Correct answer: A

Rationale: The correct answer is A: Decrease thyroid hormone production. Methimazole works by inhibiting the synthesis of thyroid hormones, specifically by blocking the enzyme responsible for this process. By reducing the production of thyroid hormones, methimazole helps to normalize the elevated levels seen in hyperthyroidism. Choices B, C, and D are incorrect. Choice B, 'Increase thyroid hormone production,' is inaccurate as methimazole actually decreases thyroid hormone production. Choice C, 'Suppress the immune system,' is unrelated to the mechanism of action of methimazole. Choice D, 'Prevent thyroid storm,' is not the primary purpose of methimazole; while it may help prevent worsening of hyperthyroidism, its main action is to reduce thyroid hormone levels.

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