Nursing Elites

1. A client with DM is scheduled to have surgery. The nurse should plan to:

• A. Give the client a regular diet as ordered.
• B. Hold the client's insulin on the morning of surgery.
• C. Monitor the client's blood glucose level closely during the perioperative period.
• D. Have the client stop taking insulin 48 hours before surgery.

Correct answer: C

Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. This is essential to ensure that the client's blood glucose levels remain within the target range and to prevent complications such as hypo- or hyperglycemia. Choices A, B, and D are incorrect because giving a regular diet as ordered, holding insulin on the morning of surgery, or stopping insulin 48 hours before surgery can lead to uncontrolled blood glucose levels, posing risks to the client's safety during the surgical procedure.

2. Nurse Noemi administers glucagon to her diabetic client and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

• A. Oral anticoagulants
• B. Anabolic steroids
• C. Beta-adrenergic blockers
• D. Thiazide diuretics

Correct answer: A

Rationale: The correct answer is A: Oral anticoagulants. Glucagon may enhance the anticoagulant effect of oral anticoagulants, increasing the risk of bleeding. This interaction can be dangerous for the patient, leading to serious complications. Choices B, C, and D are incorrect because anabolic steroids, beta-adrenergic blockers, and thiazide diuretics do not typically interact adversely with glucagon. It is crucial for healthcare providers to be aware of potential drug interactions to ensure patient safety and optimal outcomes.

3. The healthcare provider is assessing a client with suspected diabetes insipidus. Which of the following clinical manifestations would support this diagnosis?

• A. Polyuria and polydipsia
• B. Hypertension and bradycardia
• C. Weight gain and edema
• D. Oliguria and thirst

Correct answer: A

Rationale: Polyuria (excessive urination) and polydipsia (excessive thirst) are classic clinical manifestations of diabetes insipidus. In this condition, there is a deficiency of antidiuretic hormone, leading to the inability of the kidneys to concentrate urine effectively, resulting in increased urine output (polyuria) and consequent thirst (polydipsia). Hypertension and bradycardia (Choice B) are not typical findings in diabetes insipidus. Weight gain and edema (Choice C) are more indicative of conditions such as heart failure or nephrotic syndrome. Oliguria (decreased urine output) and thirst (Choice D) are contradictory symptoms to what is seen in diabetes insipidus.

4. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical manifestations should the nurse expect?

• A. Hypernatremia
• B. Hypotension
• C. Decreased urine output
• D. Polyuria

Correct answer: C

Rationale: The correct answer is C: 'Decreased urine output.' Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone, leading to water retention and decreased urine output. Therefore, the nurse should expect the client to have decreased urine output. Choices A, B, and D are incorrect. Hypernatremia (Choice A) is not typically associated with SIADH as it usually leads to dilutional hyponatremia. Hypotension (Choice B) is not a common clinical manifestation of SIADH. Polyuria (Choice D) is the opposite of what is expected in a client with SIADH, who typically presents with decreased urine output.

5. A female client with physical findings suggestive of a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, necessitating a transsphenoidal hypophysectomy. The evening before the surgery, Nurse Jacob reviews preoperative and postoperative instructions provided to the client earlier. Which postoperative instruction should the nurse emphasize?

• A. You must lie flat for 24 hours after surgery.
• B. You must avoid coughing, sneezing, and blowing your nose.
• C. You must restrict your fluid intake.
• D. You must report ringing in your ears immediately.

Correct answer: B

Rationale: Following a transsphenoidal hypophysectomy, it is crucial to avoid activities such as coughing, sneezing, and blowing the nose to prevent an increase in intracranial pressure or the risk of cerebrospinal fluid leakage. Coughing, sneezing, or nose blowing can strain the surgical site, potentially leading to complications. Lying flat for 24 hours is not typically required after this surgery. Fluid intake should be encouraged to prevent dehydration. Ringing in the ears is not a common complication associated with this type of surgery.

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