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 hepatic encephalopathy is being treated with lactulose. What is an expected outcome of this treatment?

• A. Reduction in blood ammonia levels
• B. Improvement in liver enzyme levels
• C. Decrease in bilirubin levels
• D. Increase in urine output

Correct answer: A

Rationale: Lactulose is used to treat hepatic encephalopathy by reducing blood ammonia levels through promoting its excretion via the intestines. Elevated ammonia levels contribute to the development of encephalopathy symptoms, so by lowering them, the client's neurological status can improve.

3. A client is receiving chemotherapy and is at risk for neutropenia. Which precaution should the nurse implement?

• A. Encourage regular visitors to boost morale.
• B. Ensure the client receives live vaccines.
• C. Place the client in a private room.
• D. Provide a diet high in fresh fruits and vegetables.

Correct answer: C

Rationale: Placing the client in a private room is crucial to protect them from infections due to their compromised immune system. Neutropenia, a common side effect of chemotherapy, decreases white blood cell count, making the client more susceptible to infections. By placing the client in a private room, exposure to pathogens from other individuals is minimized, reducing the risk of infection and helping maintain the client's health during this vulnerable period.

4. A 35-year-old man presents with fatigue, weight loss, and hyperpigmentation of the skin. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?

• A. Cushing's syndrome
• B. Addison's disease
• C. Hypothyroidism
• D. Pheochromocytoma

Correct answer: B

Rationale: The clinical presentation of a 35-year-old man with fatigue, weight loss, hyperpigmentation of the skin, hyponatremia, hyperkalemia, and low cortisol levels is classic for Addison's disease. These findings are consistent with primary adrenal insufficiency, where the adrenal glands fail to produce adequate cortisol. In Addison's disease, the adrenal cortex is damaged, leading to decreased cortisol production and elevated levels of ACTH. This results in symptoms such as fatigue, weight loss, and hyperpigmentation due to increased ACTH production stimulating melanocytes. Hyponatremia and hyperkalemia are common electrolyte abnormalities seen in Addison's disease due to aldosterone deficiency. Therefore, the correct diagnosis in this case is Addison's disease.

5. What instruction should the nurse give regarding the administration of alendronate to a patient with osteoporosis?

• A. Take the medication with milk.
• B. Lie down for 30 minutes after taking the medication.
• C. Take the medication with a full glass of water.
• D. Take the medication before bedtime.

Correct answer: C

Rationale: The correct instruction for administering alendronate to a patient with osteoporosis is to take the medication with a full glass of water first thing in the morning. It is important for the patient to remain upright for at least 30 minutes after taking the medication to prevent esophageal irritation. Taking alendronate with milk, lying down after intake, or taking it before bedtime can reduce the medication's effectiveness or increase the risk of side effects.

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