Nursing Elites

1. A client with a new diagnosis of diabetes mellitus is learning to self-administer insulin. Which instruction should the nurse include?

• A. Store the insulin in the freezer.
• B. Administer the insulin at the same site each time.
• C. Rotate injection sites within the same region.
• D. Shake the vial vigorously before drawing up the insulin.

Correct answer: C

Rationale: The correct instruction for a client learning to self-administer insulin is to rotate injection sites within the same region. This practice helps prevent lipodystrophy, which is a condition characterized by fat tissue changes due to repeated injections in the same spot, and also ensures consistent absorption of insulin throughout the body. Storing insulin in the freezer is incorrect as it can lead to denaturation of the insulin. Administering the insulin at the same site each time can cause lipodystrophy and inconsistent absorption. Shaking the vial vigorously before drawing up the insulin is also incorrect as it can lead to insulin degradation.

2. A client with type 1 diabetes mellitus is experiencing nausea and vomiting. What advice should the nurse give regarding insulin administration?

• A. Skip your insulin dose until you can eat.
• B. Take your insulin as prescribed, but monitor your blood glucose closely.
• C. Reduce your insulin dose by half.
• D. Only take your long-acting insulin.

Correct answer: B

Rationale: The correct advice for a client with type 1 diabetes mellitus experiencing nausea and vomiting is to take insulin as prescribed but monitor blood glucose closely. It is essential to continue insulin therapy even if not eating normally to prevent complications from high blood sugar levels. Skipping insulin doses can lead to dangerous fluctuations in blood glucose levels. Reducing the insulin dose without proper guidance can also result in uncontrolled blood sugar. Taking only long-acting insulin may not provide adequate coverage for mealtime blood sugar elevation. Therefore, the best course of action is to take prescribed insulin doses while closely monitoring blood glucose levels.

3. A client with a history of chronic heart failure is experiencing severe shortness of breath and has pink, frothy sputum. Which action should the nurse take first?

• A. Administer morphine sulfate.
• B. Place the client in a high Fowler's position.
• C. Initiate continuous ECG monitoring.
• D. Prepare the client for intubation.

Correct answer: B

Rationale: In a client with chronic heart failure experiencing severe shortness of breath and pink, frothy sputum, the priority action for the nurse is to place the client in a high Fowler's position. This position helps improve lung expansion, ease breathing, and enhance oxygenation by reducing venous return and decreasing preload on the heart. It is crucial to address the client's respiratory distress promptly before considering other interventions. Administering morphine sulfate (choice A) may be appropriate later to relieve anxiety and reduce the work of breathing, but positioning is the priority. Continuous ECG monitoring (choice C) and preparing for intubation (choice D) are important but secondary to addressing the respiratory distress and optimizing oxygenation.

4. In planning the turning schedule for a bedfast client, it is most important for the nurse to consider what assessment finding?

• A. 4+ pitting edema of both lower extremities.
• B. A Braden risk assessment scale rating score of ten.
• C. Warm, dry skin with a fever of 100° F.
• D. Hypoactive bowel sounds with infrequent bowel movements.

Correct answer: B

Rationale: A low Braden score indicates a high risk for pressure ulcers, making regular turning crucial to prevent skin breakdown.

5. The client with a history of heart failure is taking furosemide (Lasix). Which laboratory result should the nurse monitor closely?

• A. Serum sodium.
• B. Serum potassium.
• C. Serum calcium.
• D. Serum magnesium.

Correct answer: B

Rationale: Furosemide (Lasix) is a loop diuretic that can lead to potassium loss, causing hypokalemia. Monitoring serum potassium levels is crucial to prevent complications such as cardiac dysrhythmias associated with low potassium levels.

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