Nursing Elites

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

• A. Before meals and at bedtime.
• B. Only after meals.
• C. Only in the morning.
• D. Only when feeling unwell.

Correct answer: A

Rationale: The correct answer is to monitor blood glucose levels before meals and at bedtime. This timing allows for a comprehensive understanding of how the body responds to food intake and to assess fasting glucose levels. Monitoring blood glucose only after meals (Choice B) may miss important pre-meal fluctuations. Checking glucose levels only in the morning (Choice C) overlooks the impact of meals throughout the day. Monitoring blood glucose only when feeling unwell (Choice D) is reactive and does not provide consistent data for managing diabetes effectively. Therefore, monitoring blood glucose before meals and at bedtime helps in maintaining good glucose control and preventing complications.

2. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

• A. Tetanic contractions
• B. Neck vein distention
• C. Weight loss
• D. Polyuria

Correct answer: B

Rationale: Neck vein distention is a sign of fluid overload, a complication of SIADH due to water retention. Tetanic contractions (Choice A) are not typically associated with SIADH. Weight loss (Choice C) is not a common complication of SIADH, as patients often experience fluid retention and weight gain. Polyuria (Choice D) is also not a typical sign of SIADH, as the condition is characterized by water retention and decreased urine output.

3. A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level?

• A. The client with colitis
• B. The client with Cushing's syndrome
• C. The client who has been overusing laxatives
• D. The client who has sustained a traumatic burn

Correct answer: D

Rationale: Clients who have sustained traumatic burns are at a higher risk of developing hyperkalemia due to cell lysis. When cells are damaged in a traumatic burn, potassium can leak out from the intracellular space into the bloodstream, leading to elevated serum potassium levels. Colitis, Cushing's syndrome, and overuse of laxatives are not typically associated with the same degree of cell damage or potassium shifts seen in traumatic burns, making them less likely to result in such high potassium levels.

4. The healthcare provider is monitoring a client with Cushing's syndrome. Which of the following findings should the healthcare provider report?

• A. Hypotension
• B. Hyperglycemia
• C. Weight loss
• D. Hypokalemia

Correct answer: B

Rationale: In Cushing's syndrome, hyperglycemia is a common finding due to increased cortisol levels leading to insulin resistance. This can have serious implications such as diabetes mellitus and should be promptly reported for appropriate management. Hypotension (choice A) is more commonly associated with Addison's disease, not Cushing's syndrome. Weight gain rather than weight loss (choice C) is typically observed in clients with Cushing's syndrome. While hypokalemia (choice D) can occur in Cushing's syndrome due to excess cortisol affecting potassium levels, it is not as critical as hyperglycemia and may not be the priority for immediate reporting.

5. The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select one that does not apply.

• A. Place the solution on an IV pump at the prescribed rate.
• B. Monitor blood glucose every twelve (12) hours.
• C. Weigh the client weekly, first thing in the morning.
• D. Change the IV tubing every three (3) days.

Correct answer: D

Rationale: Precautions for clients receiving TPN include placing the solution on an IV pump to control the rate, monitoring blood glucose levels to detect hyperglycemia, and monitoring intake and output to assess fluid balance. Changing the IV tubing every three days is not a standard precaution for clients receiving TPN via a subclavian line.

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