Nursing Elites

1. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

• A. Monitoring for signs of hyperkalemia
• B. Checking for signs of hypoglycemia
• C. Assessing for signs of dehydration
• D. Observing for symptoms of hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

2. A client with newly diagnosed type 2 diabetes is preparing for discharge. Which statement by the client indicates a need for further teaching?

• A. I will take my insulin shots only when my blood sugar is high
• B. I need to follow a balanced diet and exercise regularly
• C. I should monitor my blood sugar levels regularly
• D. I need to take my medication as prescribed by my doctor

Correct answer: A

Rationale: In type 2 diabetes, insulin therapy is typically not the first-line treatment. Patients should follow their prescribed treatment plan, which may or may not include insulin. Taking insulin shots only when blood sugar is high can lead to uncontrolled glucose levels and complications. It is important to adhere to the prescribed medication regimen to manage diabetes effectively.

3. A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?

• A. I'm so relieved to start this medication. I really don't like having to exercise or change what I eat.
• B. It's hard to believe that there are actually medications that can treat obesity.
• C. I'm a bit nervous to start this medication because I know I'll need blood tests sometimes.
• D. I'm going to have to do some rearranging of my finances to make sure I can afford this medication.

Correct answer: A

Rationale: Choice A suggests the need for further health education as the client expresses a reluctance to exercise or change dietary habits, indicating a lack of understanding about the importance of lifestyle modifications in conjunction with medication for effective weight management. It is important for the client to comprehend that a holistic approach, including lifestyle changes, is crucial for successful obesity treatment and long-term health benefits.

4. A healthcare provider is preparing to administer a scheduled dose of intravenous (IV) metoprolol (Lopressor) to a client. The client's apical pulse is 58 beats/minute. What action should the healthcare provider take?

• A. Administer the medication as prescribed.
• B. Hold the medication and notify the healthcare provider.
• C. Give half the prescribed dose and recheck the pulse in 30 minutes.
• D. Administer the medication and then recheck the pulse in 30 minutes.

Correct answer: B

Rationale: In the scenario described, with the client's apical pulse being 58 beats/minute, holding the medication and notifying the healthcare provider is the correct action. A low pulse rate may indicate bradycardia and may necessitate dose adjustment or further evaluation by the healthcare provider to prevent potential complications.

5. A 40-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The combination of symptoms including fatigue, polyuria, polydipsia, along with laboratory findings of hyperglycemia and ketonuria strongly suggest type 1 diabetes mellitus. In type 1 diabetes mellitus, there is a deficiency of insulin leading to high blood sugar levels (hyperglycemia) and the breakdown of fats producing ketones, causing ketonuria. Type 2 diabetes mellitus typically presents differently and is more common in older individuals. Diabetes insipidus is characterized by excessive thirst and urination due to a deficiency of antidiuretic hormone, distinct from the provided clinical scenario. Hyperthyroidism may present with some overlapping symptoms like fatigue, but it does not account for the specific laboratory findings of hyperglycemia and ketonuria seen in this case.

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