Nursing Elites

1. A client with diabetes experiences Somogyi's effect. To prevent this complication, the nurse should instruct the client to:

• A. Take insulin at 2:00 PM each day
• B. Engage in physical activity daily
• C. Increase the dose of regular insulin
• D. Eat a protein and carbohydrate snack at bedtime

Correct answer: D

Rationale: Somogyi effect, also known as rebound hyperglycemia, occurs as a response to nighttime hypoglycemia. Eating a protein and carbohydrate snack at bedtime can help prevent this by stabilizing blood sugar levels throughout the night. Instructing the client to take insulin at 2:00 PM each day (Choice A) may not directly address the nighttime hypoglycemia concern. Engaging in physical activity daily (Choice B) is generally beneficial for diabetes management but may not specifically prevent Somogyi's effect. Increasing the dose of regular insulin (Choice C) without addressing the nighttime hypoglycemia issue can exacerbate the problem.

2. Low birth weight is defined as a newborn's weight of:

• A. 2500 grams or less at birth, regardless of gestational age.
• B. 1500 grams or less at birth, regardless of gestational age.
• C. 2500 grams or less at birth, according to gestational age.
• D. 1500 grams or less at birth, according to gestational age.

Correct answer: A

Rationale: Low birth weight is defined as 2500 grams or less at birth, regardless of gestational age. This means that any newborn weighing 2500 grams or less is considered to have a low birth weight, irrespective of how many weeks they were in the womb. Choices B, C, and D are incorrect because they specify a weight of 1500 grams or less, which is not the standard definition of low birth weight. The correct definition is 2500 grams or less, not influenced by gestational age.

3. A client with DM has an above-knee amputation because of severe peripheral vascular disease. Two days following surgery, when preparing the client for dinner, what is the nurse's primary responsibility?

• A. Check the client's serum glucose level
• B. Assist the client out of bed to the chair
• C. Place the client in a high-Fowler's position
• D. Ensure that the client's residual limb is elevated

Correct answer: A

Rationale: The correct answer is to check the client's serum glucose level. In a client with diabetes who just had surgery, monitoring the serum glucose level is crucial to ensure proper management of the condition. This helps in preventing complications related to blood sugar fluctuations. Assisting the client out of bed may be important but not the primary responsibility at this time. Placing the client in a high-Fowler's position or ensuring the residual limb is elevated are important interventions for comfort and circulation but are not the primary concern in this scenario.

4. Select the stage of viral hepatitis that is accurately paired with its characteristic(s).

• A. The prodromal stage: Jaundice begins
• B. The icteric stage: Flu-like symptoms occur
• C. The pre-icteric stage: Elevated urine bilirubin levels
• D. The post-icteric stage: Jaundice and dark urine occur

Correct answer: D

Rationale: The post-icteric stage of viral hepatitis is accurately described as the stage where jaundice and dark urine occur due to the accumulation of bilirubin. The resolution of jaundice and normalization of urine color are seen in this stage. Choices A, B, and C are incorrect. In the prodromal stage, symptoms like fatigue and malaise appear before jaundice. The icteric stage is characterized by jaundice, not flu-like symptoms. The pre-icteric stage does not typically involve elevated urine bilirubin levels, as this occurs after the icteric stage.

5. You are caring for a patient who has no cognitive functioning but only basic human functions such as opening the eyes and the sleep-wake cycle. What level of consciousness does this patient have?

• A. Obtunded
• B. A persistent vegetative state
• C. Locked-in syndrome
• D. Brain death

Correct answer: B

Rationale: A persistent vegetative state is characterized by the absence of cognitive functioning while basic human functions like the sleep-wake cycle are retained. In this state, the patient shows reflex movements and basic responses to stimuli but lacks awareness or higher mental functions. Choices A, C, and D are incorrect because: A) Obtunded refers to a decreased level of consciousness, not the absence of cognitive functioning. C) Locked-in syndrome is a condition where the patient is aware and awake but cannot move or communicate due to complete paralysis of nearly all voluntary muscles except for vertical eye movements and blinking. D) Brain death is the irreversible cessation of all brain activity, including the brainstem, leading to the loss of all functions of the brain.

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