Nursing Elites

1. 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.

2. The patient expects that a type 1 diabetic may receive ____ of their morning dose of insulin preoperatively:

• A. 10-20%.
• B. 25-40%.
• C. 50-60%.
• D. 85-90%.

Correct answer: B

Rationale: It is common practice to administer 25-40% of the morning dose of insulin preoperatively to prevent hypoglycemia during surgery. Giving a lower percentage (A) may not provide sufficient glycemic control, while higher percentages (C, D) can increase the risk of hypoglycemia during the surgical procedure.

3. Which of the following is a priority nursing diagnosis for a client with Addison's disease?

• A. Fluid volume deficit
• B. Risk for infection
• C. Imbalanced nutrition: Less than body requirements
• D. Disturbed body image

Correct answer: A

Rationale: The priority nursing diagnosis for a client with Addison's disease is 'Fluid volume deficit.' Addison's disease is characterized by adrenal insufficiency, resulting in decreased aldosterone production. Aldosterone plays a key role in sodium and water retention in the body. With its deficiency, there is an increased risk of dehydration and electrolyte imbalance, leading to fluid volume deficit. While infection risk, nutrition issues, and body image disturbances are also important considerations for holistic care, addressing the fluid volume deficit takes precedence due to the immediate physiological impact on the client's health and well-being.

4. The client with DM is being taught about foot care. The nurse instructs the client to:

• A. Avoid hot water when bathing the feet.
• B. Apply a moisturizing lotion to the feet, especially between the toes.
• C. Use a heating pad to warm the feet if they feel cold.
• D. Go barefoot at home to allow the feet to air out.

Correct answer: A

Rationale: The correct answer is to avoid hot water when bathing the feet. This instruction is crucial because clients with diabetes may have decreased sensation in their feet, which can put them at risk of burns from hot water. Choice B is incorrect because applying moisturizing lotion between the toes can increase moisture and promote fungal growth. Choice C is incorrect because using a heating pad can also lead to burns due to decreased sensation. Choice D is incorrect as going barefoot can increase the risk of injury and infections in clients with diabetes.

5. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse the hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

• A. Phentolamine (Regitine)
• B. Methyldopa (Aldomet)
• C. Mannitol (Osmitrol)
• D. Felodipine (Plendil)

Correct answer: A

Rationale: In a hypertensive crisis due to pheochromocytoma, the appropriate medication to administer is Phentolamine (Regitine), an alpha-adrenergic blocker. Phentolamine acts quickly to block the effects of excess catecholamines that are released in pheochromocytoma, helping to rapidly lower blood pressure. Methyldopa (Aldomet) is an alpha-2 adrenergic agonist used for chronic hypertension, not for acute crises like pheochromocytoma. Mannitol (Osmitrol) is an osmotic diuretic used to reduce intracranial pressure and treat cerebral edema, not indicated for hypertensive crises. Felodipine (Plendil) is a calcium channel blocker used for chronic management of hypertension, not for acute hypertensive crises like those seen in pheochromocytoma.

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