Nursing Elites

1. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend:

• A. Increasing saturated fat intake and fasting in the afternoon
• B. Increasing intake of vitamins B and D and taking iron supplements
• C. Eating a candy bar if lightheadedness occurs
• D. Consuming a low-carbohydrate, high-protein diet and avoiding fasting

Correct answer: D

Rationale: A low-carbohydrate, high-protein diet is beneficial for individuals with hypoglycemia as it helps in maintaining stable blood sugar levels. Choice A is incorrect as increasing saturated fat intake and fasting can worsen hypoglycemia. Choice B is incorrect as vitamins and iron supplements do not directly address hypoglycemia. Choice C is incorrect as consuming a candy bar may provide temporary relief but does not address the underlying cause of hypoglycemia.

2. A healthcare professional caring for a client who has been receiving intravenous diuretics suspects that the client is experiencing a deficient fluid volume. Which assessment finding would the healthcare professional note in a client with this condition?

• A. Lung congestion
• B. Decreased hematocrit
• C. Increased blood pressure
• D. Decreased central venous pressure (CVP)

Correct answer: D

Rationale: Decreased central venous pressure (CVP) is the correct assessment finding in a client with deficient fluid volume. This is because a decrease in CVP indicates reduced blood volume returning to the heart, which is consistent with hypovolemia. Lung congestion (Choice A) would be more indicative of fluid volume excess, not deficiency. Decreased hematocrit (Choice B) may be seen in conditions such as anemia but is not specific to deficient fluid volume. Increased blood pressure (Choice C) is not typically associated with deficient fluid volume; in fact, hypovolemia often leads to decreased blood pressure.

3. The nurse is caring for a client with primary adrenal insufficiency (Addison's disease). Which of the following laboratory findings would the nurse expect?

• A. Hypernatremia
• B. Hyperkalemia
• C. Hyperglycemia
• D. Hypercalcemia

Correct answer: B

Rationale: In primary adrenal insufficiency (Addison's disease), there is a decrease in aldosterone levels, leading to sodium loss and potassium retention. This imbalance results in hyperkalemia, making choice B the correct answer. Hypernatremia (choice A) is unlikely due to sodium loss. Hyperglycemia (choice C) and hypercalcemia (choice D) are not typically associated with primary adrenal insufficiency.

4. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical manifestations should the nurse expect?

• A. Hypernatremia
• B. Hypotension
• C. Decreased urine output
• D. Polyuria

Correct answer: C

Rationale: The correct answer is C: 'Decreased urine output.' Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone, leading to water retention and decreased urine output. Therefore, the nurse should expect the client to have decreased urine output. Choices A, B, and D are incorrect. Hypernatremia (Choice A) is not typically associated with SIADH as it usually leads to dilutional hyponatremia. Hypotension (Choice B) is not a common clinical manifestation of SIADH. Polyuria (Choice D) is the opposite of what is expected in a client with SIADH, who typically presents with decreased urine output.

5. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:

• A. Elevated serum bicarbonate and decreased blood pH.
• B. Signs of hypoglycemia earlier than expected.
• C. Symptoms of hyperglycemia due to NPH insulin peak time.
• D. Presence of sugar in the urine.

Correct answer: B

Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.

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