Nursing Elites

1. A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes?

• A. The 50-year-old client who does not engage in any physical exercise
• B. The 56-year-old client who drinks three glasses of wine daily
• C. The 42-year-old client who is 50 pounds overweight
• D. The 38-year-old client who smokes one pack of cigarettes daily

Correct answer: C

Rationale: The 42-year-old client who is 50 pounds overweight is at the highest risk for developing diabetes. Excess weight is a significant risk factor for diabetes as it can lead to insulin resistance and metabolic abnormalities. Choices A, B, and D are also risk factors for diabetes, but being overweight has a stronger association with the development of the condition compared to lack of exercise, excessive alcohol consumption, or smoking.

2. Which of the following differentiates ulcerative colitis from Crohn's disease?

• A. Crohn's disease primarily affects the left colon and rectum, while ulcerative colitis most often affects the right colon and distal ileum.
• B. Crohn's disease presents with shallow ulcerations, whereas ulcerative colitis presents with a cobblestone appearance of the mucosal lining.
• C. The extent of involvement is noncontiguous and segmented with Crohn's disease, whereas it is contiguous and diffuse with ulcerative colitis.
• D. Crohn's disease has primarily mucosal involvement, whereas it is transmural with ulcerative colitis.

Correct answer: C

Rationale: The correct answer is C. Crohn's disease is characterized by noncontiguous, segmented involvement, meaning it can affect different areas with healthy tissue in between, while ulcerative colitis involves continuous areas of inflammation. Choices A, B, and D are incorrect because Crohn's disease can affect any part of the digestive tract from mouth to anus, can present with shallow ulcerations or deep fissures, and is transmural, meaning it affects the entire thickness of the bowel wall. On the other hand, ulcerative colitis typically affects the colon and rectum, presents with a continuous pattern of inflammation, and primarily involves the mucosal lining of the colon.

3. What is a primary responsibility of a healthcare manager?

• A. Direct patient care
• B. Financial oversight
• C. Ignoring staff concerns
• D. Minimizing staff training

Correct answer: B

Rationale: Financial oversight is a primary responsibility of a healthcare manager. Healthcare managers are responsible for managing the financial aspects of healthcare facilities, including budgeting, financial planning, and ensuring financial sustainability. Direct patient care (choice A) is typically the responsibility of healthcare providers such as doctors and nurses, not managers. Ignoring staff concerns (choice C) is counterproductive and goes against effective management practices. Minimizing staff training (choice D) is also not a responsibility of a healthcare manager; on the contrary, they should ensure adequate training and development opportunities for their staff to improve patient care and overall performance.

4. A client with DM has an above-knee amputation because of severe peripheral vascular disease. Two days following surgery, when preparing the client for dinner, what is the nurse's primary responsibility?

• A. Check the client's serum glucose level
• B. Assist the client out of bed to the chair
• C. Place the client in a high-Fowler's position
• D. Ensure that the client's residual limb is elevated

Correct answer: A

Rationale: The correct answer is to check the client's serum glucose level. In a client with diabetes who just had surgery, monitoring the serum glucose level is crucial to ensure proper management of the condition. This helps in preventing complications related to blood sugar fluctuations. Assisting the client out of bed may be important but not the primary responsibility at this time. Placing the client in a high-Fowler's position or ensuring the residual limb is elevated are important interventions for comfort and circulation but are not the primary concern in this scenario.

5. Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

• A. No change
• B. Less insulin
• C. More insulin
• D. Oral antidiabetic agents

Correct answer: C

Rationale: During periods of infection, clients with type 1 diabetes may require more insulin to manage the increased blood glucose levels caused by stress and illness. Insulin needs often rise during infections due to the body's increased resistance to the effects of insulin. Therefore, increasing insulin doses is crucial to maintain blood glucose control. Choices A, B, and D are incorrect. Option A ('No change') is inaccurate because during infections, insulin requirements typically increase. Option B ('Less insulin') is incorrect as the body's increased insulin resistance during infections usually necessitates higher insulin doses. Option D ('Oral antidiabetic agents') is not suitable for type 1 diabetes management as these medications are primarily used for type 2 diabetes.

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