Nursing Elites

1. A client with Addison's disease is being educated about managing the condition during times of stress. The nurse should instruct the client to:

• A. Double the dose of corticosteroids during periods of stress.
• B. Skip the dose of corticosteroids if you feel well.
• C. Decrease fluid intake to prevent hypertension.
• D. Avoid physical activity during stressful times.

Correct answer: A

Rationale: Clients with Addison's disease should be educated to double their corticosteroid dosage during periods of stress. This is crucial to prevent adrenal crisis, as stress can increase the body's demand for cortisol. Skipping doses when feeling well can lead to an adrenal crisis if stress occurs suddenly. Decreasing fluid intake can exacerbate dehydration and electrolyte imbalances, which are already concerns in Addison's disease. Avoiding physical activity during stressful times is not the most appropriate advice; moderate physical activity can be beneficial, as long as the client is adequately managing their corticosteroid regimen.

2. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

• A. They contain exudate and provide a moist wound environment.
• B. They protect the wound from mechanical trauma and promote healing.
• C. They debride the wound and promote healing by secondary intention.
• D. They prevent the entrance of microorganisms and minimize wound discomfort.

Correct answer: C

Rationale: Wet-to-dry dressings are utilized in this case to debride the wound by removing dead tissue and promoting healing by secondary intention. Choice A is incorrect as wet-to-dry dressings do not provide a moist wound environment; instead, they promote drying to aid in debridement. Choice B is incorrect because their primary purpose is not to protect the wound but to remove dead tissue. Choice D is incorrect as the main function of wet-to-dry dressings is not to prevent the entrance of microorganisms or minimize wound discomfort.

3. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

• A. Fluid intake is less than 2,500 ml/day
• B. Urine output measures more than 200 ml/hour
• C. Blood pressure is 90/50 mm Hg
• D. The heart rate is 126 beats/minute

Correct answer: A

Rationale: The correct outcome indicating effective treatment of diabetes insipidus in a male client is a fluid intake of less than 2,500 ml/day. In diabetes insipidus, excessive urination causes increased fluid intake to compensate for the fluid loss. By effectively managing the condition, the client's fluid intake should decrease. Choices B, C, and D do not directly reflect the effectiveness of treatment for diabetes insipidus. Increased urine output (choice B) may indicate inadequate control of the condition, while low blood pressure (choice C) and a high heart rate (choice D) are not specific indicators of effective treatment for diabetes insipidus.

4. A client with hyperthyroidism is prescribed propranolol. The nurse explains that this medication is used to:

• A. Increase thyroid hormone production
• B. Decrease thyroid hormone production
• C. Relieve symptoms such as tachycardia and anxiety
• D. Prevent weight loss

Correct answer: C

Rationale: Propranolol is a beta-blocker that works by blocking the effects of adrenaline, which helps to reduce symptoms such as tachycardia (fast heart rate) and anxiety in individuals with hyperthyroidism. Choices A and B are incorrect because propranolol does not affect thyroid hormone production; it only addresses symptoms. Choice D is incorrect because propranolol does not prevent weight loss associated with hyperthyroidism.

5. A client with type 1 DM is experiencing signs of hypoglycemia. The nurse should expect which of the following symptoms?

• A. Tachycardia
• B. Polyuria
• C. Flushed skin
• D. Dry mouth

Correct answer: A

Rationale: In a client experiencing hypoglycemia, tachycardia is a common symptom. This occurs due to the release of adrenaline in response to low blood glucose levels, which stimulates the heart to beat faster. Polyuria, the increased production of urine, flushed skin, and dry mouth are not typical symptoms of hypoglycemia. Polyuria is more commonly associated with conditions like diabetes insipidus or uncontrolled diabetes mellitus. Flushed skin and dry mouth are not direct physiological responses to low blood sugar levels.

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