Nursing Elites

1. The client with type 2 DM is receiving dietary instructions from the nurse regarding the prescribed diabetic diet. The nurse determines that the client understands the instructions if the client states that:

• A. I need to skip meals if my blood glucose level is elevated.
• B. I need to eat a small meal or snack every 2 to 3 hours.
• C. I need to avoid using concentrated sweets in my diet.
• D. I need to eat a high-protein, low-carbohydrate diet.

Correct answer: C

Rationale: The correct answer is C: 'I need to avoid using concentrated sweets in my diet.' Clients with type 2 diabetes should avoid concentrated sweets as they can cause rapid spikes in blood glucose levels, which can be detrimental to their health. Option A is incorrect because skipping meals can lead to fluctuations in blood glucose levels. Option B is incorrect as it does not address the specific issue of avoiding concentrated sweets. Option D is incorrect because a high-protein, low-carbohydrate diet is not typically recommended as the primary approach for managing type 2 diabetes.

2. A client with Addison's disease is being educated about managing the condition during times of stress. The nurse should instruct the client to:

• A. Double the dose of corticosteroids during periods of stress.
• B. Skip the dose of corticosteroids if you feel well.
• C. Decrease fluid intake to prevent hypertension.
• D. Avoid physical activity during stressful times.

Correct answer: A

Rationale: Clients with Addison's disease should be educated to double their corticosteroid dosage during periods of stress. This is crucial to prevent adrenal crisis, as stress can increase the body's demand for cortisol. Skipping doses when feeling well can lead to an adrenal crisis if stress occurs suddenly. Decreasing fluid intake can exacerbate dehydration and electrolyte imbalances, which are already concerns in Addison's disease. Avoiding physical activity during stressful times is not the most appropriate advice; moderate physical activity can be beneficial, as long as the client is adequately managing their corticosteroid regimen.

3. A client with Cushing's syndrome has been prescribed a diet low in sodium. The nurse knows that the client should avoid which of the following foods?

• A. Bananas
• B. Spinach
• C. Processed meats
• D. Oatmeal

Correct answer: C

Rationale: The correct answer is C: Processed meats. Clients with Cushing's syndrome who are on a low-sodium diet should avoid processed meats because they are typically high in sodium. Bananas, spinach, and oatmeal are generally low in sodium and can be included in a low-sodium diet. Bananas are a good source of potassium, spinach is rich in vitamins and minerals, and oatmeal is a healthy whole grain option. Therefore, choices A, B, and D are not the best options to avoid for a client with Cushing's syndrome following a low-sodium diet.

4. As a nurse manager rounds on the unit, he speaks with staff, patients, and family members. Later in the day, he is in a meeting with administration. During the conversations, he considers how these interactions impact the care provided to patients on the unit. Which of the following interpersonal activities best describes this manager’s actions?

• A. Networking
• B. Employee development
• C. Coaching
• D. Monitoring

Correct answer: A

Rationale: The correct answer is 'Networking.' Networking involves building relationships and connecting with staff, patients, and family members to establish a supportive network. In this scenario, the nurse manager is engaging in networking by interacting with various individuals to understand how these interactions influence patient care. 'Employee development' involves activities aimed at enhancing employees' skills and knowledge. 'Coaching' focuses on guiding individuals to improve performance, while 'Monitoring' involves overseeing and supervising activities to ensure compliance and quality.

5. What health concerns should Nurse Oliver expect a client with hypothyroidism to report?

• A. Increased appetite and weight loss
• B. Puffiness of the face and hands
• C. Nervousness and tremors
• D. Thyroid gland swelling

Correct answer: B

Rationale: Puffiness of the face and hands is a classic symptom of hypothyroidism. This occurs due to fluid retention and is commonly observed in individuals with an underactive thyroid gland. Increased appetite and weight loss (Choice A) are more indicative of hyperthyroidism, where there is an overproduction of thyroid hormones leading to increased metabolism. Nervousness and tremors (Choice C) are associated with hyperthyroidism, not hypothyroidism. Thyroid gland swelling (Choice D) typically indicates goiter, which can be present in both hyperthyroidism and hypothyroidism but is not a specific symptom that clients with hypothyroidism commonly report.

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