Nursing Elites

1. A client with type 1 DM is experiencing hypoglycemia. Which symptom should the nurse expect to observe?

• A. Tachycardia
• B. Polyuria
• C. Flushed skin
• D. Dry mouth

Correct answer: A

Rationale: The correct answer is A: Tachycardia. In hypoglycemia, the body releases adrenaline in response to low blood glucose levels, leading to symptoms such as tachycardia (rapid heart rate). Choice B, polyuria, refers to excessive urination and is not a typical symptom of hypoglycemia. Choice C, flushed skin, is not a common symptom of hypoglycemia; instead, pale skin and sweating are more characteristic. Choice D, dry mouth, is not directly associated with hypoglycemia; rather, it can be a symptom of hyperglycemia or dehydration.

2. A client with Addison's disease is experiencing an Addisonian crisis. The nurse should expect to administer which of the following medication?

• A. Insulin
• B. Hydrocortisone
• C. Levothyroxine
• D. Methimazole

Correct answer: B

Rationale: During an Addisonian crisis, the adrenal glands are not producing enough cortisol, leading to a life-threatening situation. Hydrocortisone, a glucocorticoid, is the medication of choice in managing an Addisonian crisis. It helps replace deficient cortisol levels, stabilize blood pressure, and prevent further complications. Insulin (Choice A) is not indicated in Addison's disease unless specifically needed for diabetes management. Levothyroxine (Choice C) is used in hypothyroidism, not in Addison's disease. Methimazole (Choice D) is used to manage hyperthyroidism, which is not related to Addison's disease or its crisis.

3. 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.

4. When teaching a male client diagnosed with type 1 diabetes mellitus how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

• A. You'll need more insulin when you exercise or increase your food intake.
• B. You'll need less insulin when you exercise or reduce your food intake.
• C. You'll need less insulin when you increase your food intake.
• D. You'll need more insulin when you exercise or decrease your food intake.

Correct answer: B

Rationale: When a person with type 1 diabetes exercises, it typically lowers blood glucose levels. As a result, insulin needs are reduced when exercise or food intake is decreased. Choice A is incorrect because more insulin is not typically needed when exercise or food intake is increased. Choice C is incorrect because increasing food intake would generally require more insulin to cover the additional glucose from the food. Choice D is incorrect as decreasing food intake usually leads to a lower need for insulin.

5. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?

• A. The best time for me to exercise is every afternoon.
• B. The best time for me to exercise is right after I eat.
• C. The best time for me to exercise is after breakfast.
• D. The best time for me to exercise is after my morning snack.

Correct answer: A

Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.

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