Nursing Elites

1. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:

• A. The test needs to be repeated following a 12-hour fast.
• B. It appears you aren't following the prescribed diabetic diet.
• C. It tells us about your sugar control for the last 3 months.
• D. Your insulin regimen needs to be significantly altered.

Correct answer: C

Rationale: The correct answer is C. Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the past 3 months. This test is used to assess long-term blood sugar control in individuals with diabetes. Choice A is incorrect because fasting is not required for an HbA1c test. Choice B is judgmental and not supported by the information provided. Choice D is not the most accurate statement to make based on the HbA1c result; adjusting insulin would depend on a more comprehensive assessment of the client's overall diabetes management.

2. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

• A. Infusing I.V. fluids rapidly as ordered
• B. Encouraging increased oral intake
• C. Restricting fluids
• D. Administering glucose-containing I.V. fluids as ordered

Correct answer: C

Rationale: The correct nursing intervention for a male client with SIADH is to restrict fluids. In SIADH, there is excess release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. Restricting fluids helps prevent further dilutional hyponatremia by reducing water intake. Infusing I.V. fluids rapidly (choice A) would worsen the condition by adding more fluids, encouraging increased oral intake (choice B) is contraindicated as it adds more fluids, and administering glucose-containing I.V. fluids (choice D) is not a standard treatment for SIADH.

3. A nurse is preparing to administer insulin to a client with DM. The nurse understands that the peak time for rapid-acting insulin, such as lispro (Humalog), is:

• A. 30 minutes to 1 hour after administration.
• B. 1 to 2 hours after administration.
• C. 2 to 4 hours after administration.
• D. 3 to 5 hours after administration.

Correct answer: A

Rationale: The correct answer is A: 30 minutes to 1 hour after administration. Rapid-acting insulins like lispro, such as Humalog, peak quickly within 30 minutes to 1 hour after administration. This peak time is crucial to monitor for potential hypoglycemia, which is most likely to occur during this period. Choice B is incorrect as it suggests a longer peak time for rapid-acting insulin, which is inaccurate. Choices C and D are also incorrect because they indicate even longer peak times, which do not align with the rapid onset and peak action of lispro insulin.

4. Nurse Noemi administers glucagon to her diabetic client and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

• A. Oral anticoagulants
• B. Anabolic steroids
• C. Beta-adrenergic blockers
• D. Thiazide diuretics

Correct answer: A

Rationale: The correct answer is A: Oral anticoagulants. Glucagon may enhance the anticoagulant effect of oral anticoagulants, increasing the risk of bleeding. This interaction can be dangerous for the patient, leading to serious complications. Choices B, C, and D are incorrect because anabolic steroids, beta-adrenergic blockers, and thiazide diuretics do not typically interact adversely with glucagon. It is crucial for healthcare providers to be aware of potential drug interactions to ensure patient safety and optimal outcomes.

5. The client with hypothyroidism is being educated by the healthcare provider about taking levothyroxine. Which of the following instructions should be included?

• A. Take the medication with meals
• B. Take the medication at bedtime
• C. Take the medication on an empty stomach in the morning
• D. Take the medication with a glass of milk

Correct answer: C

Rationale: The correct answer is to take levothyroxine on an empty stomach in the morning. This instruction is essential to enhance absorption and efficacy of the medication. Taking levothyroxine with meals, at bedtime, or with a glass of milk can interfere with its absorption and effectiveness, leading to suboptimal treatment outcomes.

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