Nursing Elites

1. A client with diabetes mellitus visits a health care clinic. The client's diabetes was previously well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Prednisone (Deltasone)
• B. Atenolol (Tenormin)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: A

Rationale: Prednisone, a corticosteroid, can increase blood glucose levels by promoting gluconeogenesis and decreasing glucose uptake by cells. This medication can lead to hyperglycemia in patients, especially those with diabetes mellitus. Atenolol (Tenormin) is a beta-blocker and is not known to significantly affect blood glucose levels. Phenelzine (Nardil) is a monoamine oxidase inhibitor used to treat depression and anxiety disorders; it does not typically impact blood glucose levels. Allopurinol (Zyloprim) is a xanthine oxidase inhibitor used to manage gout and does not interfere with blood glucose regulation.

2. A nurse is preparing to administer insulin to a client with DM. The nurse understands that the peak time for rapid-acting insulin, such as lispro (Humalog), is:

• A. 30 minutes to 1 hour after administration.
• B. 1 to 2 hours after administration.
• C. 2 to 4 hours after administration.
• D. 3 to 5 hours after administration.

Correct answer: A

Rationale: The correct answer is A: 30 minutes to 1 hour after administration. Rapid-acting insulins like lispro, such as Humalog, peak quickly within 30 minutes to 1 hour after administration. This peak time is crucial to monitor for potential hypoglycemia, which is most likely to occur during this period. Choice B is incorrect as it suggests a longer peak time for rapid-acting insulin, which is inaccurate. Choices C and D are also incorrect because they indicate even longer peak times, which do not align with the rapid onset and peak action of lispro insulin.

3. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

• A. Infusing I.V. fluids rapidly as ordered
• B. Encouraging increased oral intake
• C. Restricting fluids
• D. Administering glucose-containing I.V. fluids as ordered

Correct answer: C

Rationale: The correct nursing intervention for a male client with SIADH is to restrict fluids. In SIADH, there is excess release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. Restricting fluids helps prevent further dilutional hyponatremia by reducing water intake. Infusing I.V. fluids rapidly (choice A) would worsen the condition by adding more fluids, encouraging increased oral intake (choice B) is contraindicated as it adds more fluids, and administering glucose-containing I.V. fluids (choice D) is not a standard treatment for SIADH.

4. When instructing the female client diagnosed with hyperparathyroidism about diet, Nurse Gina should stress the importance of which of the following?

• A. Restricting fluids
• B. Restricting sodium
• C. Forcing fluids
• D. Restricting potassium

Correct answer: C

Rationale: The correct answer is C: Forcing fluids. Nurse Gina should stress the importance of forcing fluids to help prevent kidney stones and hypercalcemia in clients with hyperparathyroidism. Restricting fluids (choice A) is not recommended as dehydration can worsen the condition. Restricting sodium (choice B) is not directly related to the management of hyperparathyroidism. Restricting potassium (choice D) is not typically necessary in hyperparathyroidism unless hyperkalemia is present.

5. A client with diabetes mellitus is experiencing polyuria, polydipsia, and polyphagia. Which of the following actions should the nurse take?

• A. Administer insulin
• B. Encourage increased fluid intake
• C. Monitor for signs of dehydration
• D. Check blood glucose levels

Correct answer: D

Rationale: Polyuria, polydipsia, and polyphagia are classic signs of hyperglycemia, indicating high blood glucose levels. The priority action for the nurse is to check the client's blood glucose levels to assess the severity of hyperglycemia and determine the need for appropriate interventions. Administering insulin (Choice A) may be necessary based on the blood glucose levels but should only be done after confirming the current status. Encouraging increased fluid intake (Choice B) may exacerbate the symptoms by further diluting the blood glucose concentration. While monitoring for signs of dehydration (Choice C) is important in the long term, the immediate action should focus on determining the blood glucose levels first.

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