Nursing Elites

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

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

Correct answer: A

Rationale: In SIADH, there is excessive release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. Hyponatremia is a hallmark finding in SIADH due to the imbalance between water and sodium levels. Hyperkalemia (Choice B) is not typically associated with SIADH. Hypercalcemia (Choice C) involves elevated calcium levels, which are not directly related to SIADH. Hypernatremia (Choice D) is the opposite of what occurs in SIADH, where sodium levels are usually diluted due to water retention.

2. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

• A. Hypotension.
• B. Thick, coarse skin.
• C. Deposits of adipose tissue in the trunk and dorsocervical area.
• D. Weight gain in arms and legs.

Correct answer: C

Rationale: In Cushing's syndrome, the characteristic features include central obesity with deposits of adipose tissue in the trunk and dorsocervical area, often referred to as a 'buffalo hump.' Hypotension (Choice A) is not typically associated with Cushing's syndrome; instead, hypertension is more common. Thick, coarse skin (Choice B) is seen in conditions like hypothyroidism, not specifically in Cushing's syndrome. Weight gain in the arms and legs (Choice D) is not a typical finding in Cushing's syndrome; rather, weight gain is more prominent in the central areas of the body.

3. The nurse is caring for a client with DM who is experiencing ketoacidosis. The nurse should prioritize which action?

• A. Administering insulin intravenously.
• B. Giving the client sips of water.
• C. Monitoring the client's urine output.
• D. Applying a heating pad to the client's abdomen.

Correct answer: A

Rationale: Administering insulin intravenously is the priority action for managing diabetic ketoacidosis. Insulin helps lower blood glucose levels and halts the production of ketones, addressing the underlying cause of ketoacidosis. Giving sips of water (Choice B) may be necessary for hydration, but it does not address the immediate life-threatening issue of ketoacidosis. Monitoring urine output (Choice C) is important for assessing renal function but is not the priority over administering insulin. Applying a heating pad (Choice D) is not indicated and can potentially worsen the condition in ketoacidosis.

4. 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.

5. A client with type 2 diabetes mellitus is taking metformin. The nurse should monitor the client for which of the following potential side effects?

• A. Lactic acidosis
• B. Hypokalemia
• C. Hyperglycemia
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A: Lactic acidosis. Metformin, a common medication for type 2 diabetes mellitus, can lead to lactic acidosis, particularly in individuals with renal impairment or other predisposing factors. Monitoring for signs and symptoms of lactic acidosis, such as muscle pain, weakness, trouble breathing, dizziness, and slow or irregular heartbeat, is crucial when a client is taking metformin. Choice B, hypokalemia, is not a common side effect of metformin. Choice C, hyperglycemia, is contrary to the intended effect of metformin, which is to lower blood glucose levels. Choice D, weight gain, is not typically associated with metformin use; in fact, metformin may even contribute to weight loss in some individuals.

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