Nursing Elites

1. A client with hyperthyroidism is receiving radioactive iodine therapy. The nurse should monitor for which of the following side effects?

• A. Hypothyroidism
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypercalcemia

Correct answer: A

Rationale: The correct answer is A: Hypothyroidism. Radioactive iodine therapy is used to treat hyperthyroidism by destroying thyroid tissue and reducing hormone production. This can lead to an underactive thyroid, resulting in hypothyroidism. Hyperkalemia (choice B) is an elevated potassium level, usually not associated with radioactive iodine therapy. Hyponatremia (choice C) is a low sodium level, which is also not a common side effect of this therapy. Hypercalcemia (choice D) is an elevated calcium level, unrelated to radioactive iodine therapy for hyperthyroidism.

2. A client with a nasogastric tube requires irrigation once every shift. The client's serum electrolyte results show a potassium level of 4.5 mEq/L and a sodium level of 132 mEq/L. Based on these findings, which solution should the nurse use for nasogastric tube irrigation?

• A. Tap water
• B. Sterile water
• C. Sodium chloride
• D. Normal saline

Correct answer: C

Rationale: The correct solution for nasogastric tube irrigation in this scenario is sodium chloride. The client's low sodium level of 132 mEq/L indicates the need to avoid further imbalance, making sodium chloride the most appropriate choice. Using tap water, which lacks electrolytes, or sterile water could potentially exacerbate the electrolyte imbalance. Normal saline, while similar to sodium chloride, may not be the best choice as it contains a higher concentration of sodium, which could further elevate the client's already borderline sodium level.

3. The nurse is caring for a client with a history of adrenal insufficiency. The nurse should monitor for which of the following signs of an Addisonian crisis?

• A. Hypertension
• B. Hyperglycemia
• C. Severe hypotension
• D. Tachycardia

Correct answer: C

Rationale: In an Addisonian crisis, there is a lack of adrenal hormones leading to severe hypotension. Hypertension (choice A) is not a typical sign of Addisonian crisis but can occur in conditions like pheochromocytoma. Hyperglycemia (choice B) is not a characteristic sign of an Addisonian crisis. Tachycardia (choice D) may occur as a compensatory mechanism in response to hypotension, but severe bradycardia is more common in an Addisonian crisis.

4. A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which of the following interventions should the nurse implement first?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct first intervention in the treatment of a client with diabetic ketoacidosis (DKA) is to start an intravenous line and infuse normal saline. This is essential for fluid resuscitation to restore intravascular volume and improve perfusion. Administering intravenous insulin can lead to further potassium depletion without first addressing dehydration and electrolyte imbalances. Monitoring serum potassium levels is important but should follow fluid resuscitation to avoid life-threatening hypokalemia. Obtaining an arterial blood gas (ABG) is necessary to assess the acid-base status but is not the initial priority when managing DKA.

5. How often should rotation sites for insulin injection be separated from one another?

• A. Every third day.
• B. Every week.
• C. Every 2-3 weeks.
• D. Every 2-4 weeks.

Correct answer: C

Rationale: Insulin injection sites should be rotated every 2-3 weeks to prevent lipodystrophy and ensure proper insulin absorption. Option A ('Every third day') is too frequent and does not allow enough time for the previous site to heal properly. Option B ('Every week') might not provide adequate time for the tissue to recover. Option D ('Every 2-4 weeks') could potentially lead to overuse of a single injection site, increasing the risk of lipodystrophy and inconsistent insulin absorption. Therefore, the recommended interval of every 2-3 weeks is optimal for insulin injection site rotation.

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