Nursing Elites

1. The client with DM who is taking insulin develops a fever and becomes confused. Which action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer a fever-reducing medication.
• C. Give the client fluids to drink.
• D. Notify the health care provider.

Correct answer: A

Rationale: In a client with diabetes mellitus (DM) taking insulin, the development of fever and confusion may indicate hyperglycemia or diabetic ketoacidosis. Checking the blood glucose level is the priority action in this situation. This will help determine if the symptoms are related to high blood sugar levels, guiding further interventions. Administering a fever-reducing medication (choice B) addresses only the symptom of fever and does not address the underlying cause. Providing fluids to drink (choice C) is important but should come after addressing the potential hyperglycemia or diabetic ketoacidosis. Notifying the health care provider (choice D) can be important, but immediate action to evaluate and manage the client's condition should precede contacting the provider.

2. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

• A. Administer desmopressin while the suspension is cold.
• B. Your condition isn't chronic, so you won't need to wear a medical identification bracelet.
• C. You may not be able to use desmopressin nasally if you have nasal discharge or blockage.
• D. You won't need to monitor your fluid intake and output after you start taking desmopressin.

Correct answer: C

Rationale: The correct instruction is choice C: 'You may not be able to use desmopressin nasally if you have nasal discharge or blockage.' Nasal congestion or blockage can interfere with the absorption of nasally administered desmopressin. Choices A, B, and D are incorrect. Choice A is unnecessary as the temperature of the suspension does not impact desmopressin administration. Choice B is incorrect as wearing a medical identification bracelet is essential for individuals with diabetes insipidus to alert healthcare providers in case of emergencies. Choice D is incorrect as monitoring fluid intake and output is crucial when taking desmopressin to ensure proper hydration and medication effectiveness.

3. 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.

4. A client with diabetes mellitus visits a health care clinic. The client's diabetes was previously well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Prednisone (Deltasone)
• B. Atenolol (Tenormin)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: A

Rationale: Prednisone, a corticosteroid, can increase blood glucose levels by promoting gluconeogenesis and decreasing glucose uptake by cells. This medication can lead to hyperglycemia in patients, especially those with diabetes mellitus. Atenolol (Tenormin) is a beta-blocker and is not known to significantly affect blood glucose levels. Phenelzine (Nardil) is a monoamine oxidase inhibitor used to treat depression and anxiety disorders; it does not typically impact blood glucose levels. Allopurinol (Zyloprim) is a xanthine oxidase inhibitor used to manage gout and does not interfere with blood glucose regulation.

5. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, Nurse Tina assesses the client, who now has nausea, a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

• A. Diabetic ketoacidosis
• B. Thyroid crisis
• C. Hypoglycemia
• D. Tetany

Correct answer: B

Rationale: The correct answer is B: Thyroid crisis. Thyroid crisis, also known as thyroid storm, is a life-threatening condition that can occur after a thyroidectomy. Symptoms include high fever, tachycardia, extreme restlessness, and other signs of severe hyperthyroidism. Diabetic ketoacidosis (choice A) is a complication of diabetes characterized by hyperglycemia, ketosis, and acidosis, not typically seen post-thyroidectomy. Hypoglycemia (choice C) is low blood sugar levels and would not present with the symptoms described. Tetany (choice D) is a condition of involuntary muscle spasms due to low calcium levels and is not directly related to the symptoms observed in this scenario.

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