Nursing Elites

1. A client with newly diagnosed diabetes mellitus is being discharged home. Which statement indicates the client understands the instructions about managing blood glucose levels?

• A. I will test my blood glucose level once a week.
• B. I should eat a snack if my blood glucose is 70 mg/dl.
• C. If I feel shaky, I should take another dose of insulin.
• D. It's okay to skip a meal if I'm not hungry.

Correct answer: B

Rationale: Choice B is the correct answer. Eating a snack when blood glucose is low (70 mg/dl) can help prevent hypoglycemia. It is important for clients with diabetes to manage their blood glucose levels to prevent complications, and consuming a snack when glucose levels drop can help maintain the balance.

2. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which response by the nurse is most appropriate?

• A. In most cases, breast cancer is not caused by the BRCA gene.
• B. It depends on how you will feel if the test is positive for the BRCA gene.
• C. There are many things to consider before deciding to have genetic testing.
• D. You should decide first whether you are willing to have a bilateral mastectomy.

Correct answer: C

Rationale: The most appropriate response by the nurse is C: 'There are many things to consider before deciding to have genetic testing.' Genetic testing for BRCA gene mutations is a complex decision that involves various factors such as emotional readiness, potential impact on insurance and employability, and the implications of test results. Option A is incorrect because although most breast cancers are not related to BRCA gene mutations, individuals with these mutations have a significantly higher risk. Option B is not ideal as it oversimplifies the decision-making process by focusing solely on emotional aspects. Option D is incorrect as it implies a predetermined course of action (mastectomy) before even undergoing genetic testing, which is not appropriate.

3. The nurse formulates a nursing diagnosis of 'High risk for ineffective airway clearance' for a client with myasthenia gravis. What is the most likely etiology for this nursing diagnosis?

• A. Pain when coughing.
• B. Diminished cough effort.
• C. Thick, dry secretions.
• D. Excessive inflammation.

Correct answer: B

Rationale: The correct answer is B: Diminished cough effort. Clients with myasthenia gravis often experience muscle weakness, including respiratory muscles, which can lead to diminished cough effort. This weakness can result in ineffective airway clearance, putting the client at a high risk. Pain when coughing (choice A) is not directly related to the etiology of ineffective airway clearance in myasthenia gravis. While thick, dry secretions (choice C) and excessive inflammation (choice D) can contribute to airway clearance issues, the primary concern in myasthenia gravis is the muscle weakness affecting cough effort.

4. The healthcare provider prescribes naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, 'The pills don't seem to be working. They are not helping the pain at all.' Which factor should influence the nurse's response?

• A. Noncompliance is probably affecting optimal medication effectiveness.
• B. Drug dosage is inadequate and needs to be increased to three times a day.
• C. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream.
• D. NSAID response is variable, and trying another NSAID may be more effective.

Correct answer: D

Rationale: Different NSAIDs work differently in individuals. If a patient is not experiencing relief with one NSAID, switching to a different one may provide better pain management. This variability in response is common among NSAIDs due to individual differences in drug metabolism and efficacy.

5. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

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