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1. Which of the following is the best indicator of long-term glycemic control in a patient with diabetes?
- A. Fasting blood glucose levels.
- B. Postprandial blood glucose levels.
- C. Hemoglobin A1c.
- D. Random blood glucose levels.
Correct answer: C
Rationale: The correct answer is C, Hemoglobin A1c. Hemoglobin A1c measures the average blood glucose level over the past 2-3 months, providing a reliable indicator of long-term glycemic control. Fasting blood glucose levels (choice A) only offer a snapshot of the current glucose level and can fluctuate throughout the day. Postprandial blood glucose levels (choice B) reflect glucose levels after meals but do not give a comprehensive view of long-term control. Random blood glucose levels (choice D) are taken at any time and lack the consistency needed to assess long-term glycemic control effectively. Therefore, Hemoglobin A1c is the superior choice for monitoring and managing diabetes over an extended period.
2. A client with acute kidney injury (AKI) weighing 50kg and having a potassium level of 6.7mEq/L (6.7mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first?
- A. Calcium acetate, one tablet by mouth
- B. Sodium polystyrene sulfonate, 15 grams by mouth
- C. Epoetin Alfa, recombinant, 2,500 units subcutaneously
- D. Sevelamer, one tablet by mouth
Correct answer: B
Rationale: In a client with acute kidney injury (AKI) and hyperkalemia, the priority intervention is to lower the potassium level swiftly. Sodium polystyrene sulfonate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, reducing the overall potassium levels. Calcium acetate, epoetin alfa, and sevelamer are not indicated for the immediate reduction of potassium levels in hyperkalemia. Calcium acetate is used to control phosphate levels, epoetin alfa is a medication to treat anemia by stimulating red blood cell production, and sevelamer is a phosphate binder used in chronic kidney disease to reduce phosphate levels.
3. A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the:
- A. Back of the mouth.
- B. Nose.
- C. Sinus channel below the right eye.
- D. Upper gingival mucosa in the space between the upper gums and lip.
Correct answer: D
Rationale: The correct answer is D: Upper gingival mucosa in the space between the upper gums and lip. A transsphenoidal hypophysectomy involves accessing the pituitary gland through an incision in the upper gingival mucosa, providing direct access to the pituitary gland without external scars. Choices A, B, and C are incorrect because the surgery is not performed through the back of the mouth, the nose, or the sinus channel below the right eye. It is crucial for the client to understand the specific location of the incision to ensure accurate preoperative education and expectations.
4. Which of the following is a key symptom of hyperthyroidism?
- A. Weight loss.
- B. Weight gain.
- C. Tachycardia.
- D. Dry skin.
Correct answer: A
Rationale: The correct answer is weight loss. In hyperthyroidism, there is an excess production of thyroid hormones leading to an increased metabolic rate. This increased metabolism can result in weight loss despite normal or increased appetite. Choice B (Weight gain) is more commonly associated with hypothyroidism where the metabolic rate is decreased. Choice C (Tachycardia) is another common symptom of hyperthyroidism due to the effects of thyroid hormones on the heart, causing an increased heart rate. Choice D (Dry skin) is not a typical symptom of hyperthyroidism; instead, it is more commonly associated with hypothyroidism.
5. While assessing a female client who is chronically fatigued and was recently diagnosed with adrenal insufficiency, the client tells the nurse that she is very nervous that her hospitalization will cause her to lose her job. Which intervention should the nurse implement first?
- A. Teach the client about the risk for infection.
- B. Offer support and care measures to reduce anxiety and stress.
- C. Encourage the client to rest quietly to reduce fatigue.
- D. Place a referral to social services to discuss financial options.
Correct answer: B
Rationale: In this scenario, the priority intervention for the nurse is to offer support and care measures to reduce anxiety and stress. Addressing the client's emotional distress is crucial as the stress can exacerbate adrenal insufficiency. While teaching the client about the risk for infection (Choice A) is important, addressing the immediate emotional needs takes precedence. Encouraging the client to rest quietly (Choice C) is beneficial but does not directly address the client's current distress about job loss. Referring the client to social services (Choice D) for financial options is important, but at this moment, addressing the client's anxiety is the priority to promote emotional well-being.
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