Nursing Elites

1. A client with diabetes mellitus is being educated on the signs and symptoms of hypoglycemia. Which of the following symptoms should the client be instructed to report immediately?

• A. Shakiness
• B. Sweating
• C. Confusion
• D. Increased thirst

Correct answer: C

Rationale: Confusion is a critical symptom of hypoglycemia that indicates the brain is not receiving enough glucose, potentially leading to serious complications like unconsciousness or seizures. Immediate reporting of confusion is essential for prompt intervention to prevent worsening of hypoglycemia. Shakiness and sweating are early warning signs of hypoglycemia but may not always require immediate intervention. Increased thirst is a symptom commonly associated with hyperglycemia rather than hypoglycemia.

2. A client with type 1 diabetes mellitus presents with nausea, vomiting, and abdominal pain. The nurse suspects diabetic ketoacidosis (DKA). Which of the following lab findings would confirm this diagnosis?

• A. Serum glucose of 180 mg/dL
• B. Serum bicarbonate of 22 mEq/L
• C. Blood pH of 7.25
• D. Urine specific gravity of 1.020

Correct answer: C

Rationale: A blood pH of 7.25 is a critical finding in diabetic ketoacidosis (DKA) as it indicates metabolic acidosis, which is a hallmark of this condition. In DKA, there is an accumulation of ketones in the blood, leading to increased acidity. The serum glucose level is typically elevated in DKA, often exceeding 250 mg/dL. A serum bicarbonate level less than 18 mEq/L is usually seen in DKA due to the metabolic acidosis. Urine specific gravity is not a specific indicator for DKA and may vary depending on the individual's hydration status. Therefore, the correct lab finding that confirms DKA in this scenario is a blood pH of 7.25.

3. A healthcare provider caring for a client with severe malnutrition reviews the laboratory results and notes a magnesium level of 1.0 mg/dL. Which electrocardiographic change would the healthcare provider expect to note based on the magnesium level?

• A. Prominent U waves
• B. Prolonged PR interval
• C. Depressed ST segment
• D. Widened QRS complexes

Correct answer: C

Rationale: A magnesium level of 1.0 mg/dL can cause a depressed ST segment on the ECG. Magnesium deficiency commonly leads to ST segment depression on an electrocardiogram. Prominent U waves are associated with hypokalemia, prolonged PR interval is seen in conditions like first-degree heart block, and widened QRS complexes are typically related to conditions affecting the conduction system of the heart, such as bundle branch blocks.

4. Knowing that gluconeogenesis helps to maintain blood glucose levels, a healthcare provider should:

• A. Document weight changes due to fatty acid mobilization.
• B. Evaluate the patient's sensitivity to low room temperatures due to decreased adipose tissue insulation.
• C. Protect the patient from sources of infection due to decreased cellular protein deposits.
• D. Do all of the above.

Correct answer: D

Rationale: Gluconeogenesis is a process where the body synthesizes glucose from non-carbohydrate sources to maintain blood glucose levels. Documenting weight changes due to fatty acid mobilization is important as it can impact the patient's metabolic status. Evaluating the patient's sensitivity to low room temperatures because of decreased adipose tissue insulation is crucial to prevent hypothermia. Protecting the patient from sources of infection due to decreased cellular protein deposits is essential to prevent complications. Therefore, all the options are relevant considerations in managing a patient undergoing gluconeogenesis, making option D the correct answer.

5. The client with DM is being taught by the nurse about the importance of monitoring blood glucose levels. The nurse should instruct the client to:

• A. Check blood glucose only when feeling unwell.
• B. Check blood glucose before meals and at bedtime.
• C. Check blood glucose only after meals.
• D. Check blood glucose only in the morning.

Correct answer: B

Rationale: The correct answer is to check blood glucose before meals and at bedtime. Monitoring blood glucose levels before meals allows the client to adjust their insulin or oral antidiabetic medications based on their current levels. Checking at bedtime helps in ensuring blood glucose levels are at a safe range throughout the night. Option A is incorrect because blood glucose should be monitored regularly as part of diabetes management, not just when feeling unwell. Option C is incorrect because checking only after meals does not provide a complete picture of blood glucose control throughout the day. Option D is incorrect as checking only in the morning does not cover the full spectrum of blood glucose variations that can occur during the day.

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