Nursing Elites

1. A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level?

• A. The client with colitis
• B. The client with Cushing's syndrome
• C. The client who has been overusing laxatives
• D. The client who has sustained a traumatic burn

Correct answer: D

Rationale: Clients who have sustained traumatic burns are at a higher risk of developing hyperkalemia due to cell lysis. When cells are damaged in a traumatic burn, potassium can leak out from the intracellular space into the bloodstream, leading to elevated serum potassium levels. Colitis, Cushing's syndrome, and overuse of laxatives are not typically associated with the same degree of cell damage or potassium shifts seen in traumatic burns, making them less likely to result in such high potassium levels.

2. A client with DM is being taught about the importance of foot care by a nurse. Which instruction should the nurse include?

• A. Use a heating pad to warm your feet.
• B. Avoid walking barefoot.
• C. Soak your feet in hot water every night.
• D. Wear tight shoes to protect your feet.

Correct answer: B

Rationale: The correct instruction for the nurse to include is to advise the client to avoid walking barefoot. This recommendation is crucial for clients with diabetes to prevent foot injuries and infections. Walking barefoot can lead to unnoticed wounds or ulcers due to reduced sensation in the feet (neuropathy) common in diabetes. Choice A is incorrect as heating pads can cause burns and should be avoided. Choice C is incorrect because soaking feet in hot water can also lead to burns and skin damage. Choice D is incorrect as tight shoes can increase the risk of pressure sores and restrict blood flow, which is detrimental for individuals with diabetes.

3. The client with type 1 DM asks why it is necessary to rotate injection sites when managing insulin therapy. The nurse's best response is:

• A. It helps prevent skin irritation.
• B. It helps prevent scar tissue buildup.
• C. It ensures more consistent insulin absorption.
• D. It makes the injections less painful.

Correct answer: C

Rationale: Rotating injection sites is necessary to ensure more consistent insulin absorption. This practice helps maintain stable blood glucose levels by preventing the formation of lipohypertrophy (fatty lumps under the skin) at injection sites. Choices A and B are incorrect as the primary purpose of rotating injection sites is not focused on preventing skin irritation or scar tissue buildup. While rotating injection sites may contribute to reducing pain over time, the primary benefit is the consistency in insulin absorption to support glycemic control, making choice D less relevant.

4. During preoperative teaching for a female client undergoing subtotal thyroidectomy, which statement should the nurse include?

• A. The head of your bed must remain flat for 24 hours after surgery.
• B. You should avoid deep breathing and coughing after surgery.
• C. You won't be able to swallow for the first day or two.
• D. You must avoid hyperextending your neck after surgery.

Correct answer: D

Rationale: The correct answer is D. Instructing the client to avoid hyperextending the neck after thyroid surgery is crucial to prevent stress on the surgical site and reduce the risk of complications such as strain on the incision or damage to the healing tissues. Choices A, B, and C are incorrect because: A) Keeping the head of the bed flat for 24 hours is not necessary after a thyroidectomy; elevation of the head of the bed can actually help reduce swelling and improve comfort. B) Encouraging deep breathing and coughing after surgery is essential to prevent respiratory complications such as pneumonia, so this advice is incorrect. C) Difficulty swallowing after thyroid surgery is not a typical outcome, so this statement is inaccurate and should not be included in the preoperative teaching.

5. A client is receiving levothyroxine for hypothyroidism. Which of the following findings would indicate that the medication is effective?

• A. Decreased heart rate
• B. Increased weight
• C. Increased energy levels
• D. Decreased appetite

Correct answer: C

Rationale: The correct answer is C: Increased energy levels. When a client with hypothyroidism is receiving levothyroxine, increased energy levels indicate that thyroid hormone levels are being normalized, which is a positive response to treatment. This improvement reflects the effectiveness of the medication in addressing the underlying hypothyroidism. Choices A, B, and D are incorrect. Decreased heart rate and decreased appetite may be symptoms of hypothyroidism and would not necessarily indicate the effectiveness of levothyroxine. Increased weight could also be a symptom of hypothyroidism and does not directly reflect the medication's effectiveness.

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