Nursing Elites

1. A client with diabetes mellitus is experiencing polyuria, polydipsia, and polyphagia. What do these symptoms indicate?

• A. Hypoglycemia
• B. Diabetic ketoacidosis (DKA)
• C. Hyperosmolar hyperglycemic state (HHS)
• D. Insulin shock

Correct answer: B

Rationale: Polyuria, polydipsia, and polyphagia are classic signs of diabetic ketoacidosis (DKA), which occurs due to a combination of hyperglycemia and ketone production. Hypoglycemia (Choice A) is characterized by low blood sugar levels, leading to symptoms like confusion, shakiness, and sweating, which are different from the symptoms described in the scenario. Hyperosmolar hyperglycemic state (HHS) (Choice C) typically presents with severe hyperglycemia, dehydration, and altered mental status, rather than the triad of symptoms mentioned. Insulin shock (Choice D) refers to a severe hypoglycemic reaction due to excessive insulin, manifesting with confusion, sweating, and rapid heartbeat, not the symptoms seen in the client with diabetes mellitus described in this scenario.

2. A client with a history of seizures is prescribed phenytoin. Which instruction should the nurse include in the discharge teaching?

• A. Report any signs of a sore throat or fever immediately
• B. Take the medication with antacids to reduce stomach upset
• C. Discontinue the medication if you feel drowsy
• D. Increase the dosage if you experience an aura

Correct answer: A

Rationale: The correct answer is A: 'Report any signs of a sore throat or fever immediately.' Phenytoin can cause blood dyscrasias, which can manifest as a sore throat or fever. These symptoms could indicate a serious side effect that requires immediate medical attention. Choice B is incorrect because phenytoin should not be taken with antacids as they can decrease its absorption. Choice C is incorrect because discontinuing phenytoin abruptly can lead to rebound seizures; drowsiness is a common side effect that may improve with time. Choice D is incorrect because adjusting the dosage of phenytoin should only be done under healthcare provider supervision, not based on experiencing an aura.

3. What should the nurse caring for a 6-year-old child with acute glomerulonephritis anticipate as the most challenging aspect of care to implement?

• A. Forced fluids
• B. Increased feedings
• C. Bed rest
• D. Frequent position changes

Correct answer: C

Rationale: The correct answer is C: Bed rest. During the acute phase of glomerulonephritis, bed rest is usually recommended. A diet of restricted fluid, sodium, potassium, and phosphate is initially required. Bed rest can be very challenging to implement with an active 6-year-old child. Forced fluids (choice A) may be necessary to maintain hydration. Increased feedings (choice B) may not be as difficult to implement as bed rest. Frequent position changes (choice D) may also be important but are not typically the most challenging aspect of care for a child with acute glomerulonephritis.

4. Methotrexate is prescribed for a client with rheumatoid arthritis (RA) who is also taking aspirin. What is the best explanation for the nurse to provide as to why a second medication has been added?

• A. Methotrexate slows the disease progression while aspirin controls the symptoms.
• B. Methotrexate helps to reduce the side effects of aspirin.
• C. Methotrexate has fewer harmful side effects than aspirin.
• D. Methotrexate enhances the effect of aspirin.

Correct answer: A

Rationale: The correct answer is A. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that slows the progression of rheumatoid arthritis (RA), while aspirin helps control symptoms such as pain and inflammation. Therefore, the combination of methotrexate and aspirin is beneficial in managing RA by addressing both disease progression and symptom control. Choices B, C, and D are incorrect because methotrexate is not added to reduce the side effects of aspirin, has different side effects compared to aspirin, and does not enhance the effect of aspirin.

5. When selecting patient problems for the 4-year-old child with nephrosis, what should be a priority for the nurse?

• A. Impaired body image
• B. Skin impairment
• C. Nutritional deficit
• D. Injury

Correct answer: B

Rationale: The correct answer is B: Skin impairment. Nephrosis is characterized by gross edema, making skin care a priority. Skin impairment can result from the edema and needs close monitoring and management. While nutritional deficit and injury are important considerations in patient care, they are not the priority when dealing with a child with nephrosis. Impaired body image is not typically a priority in the immediate care of a young child with nephrosis.

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