Nursing Elites

1. A client with DM is scheduled for surgery. The nurse should plan to:

• A. Monitor the client's blood glucose level closely during the perioperative period.
• B. Give the client a regular diet as ordered.
• C. Have the client stop taking insulin 48 hours before surgery.
• D. Hold the client's insulin on the morning of surgery.

Correct answer: A

Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. For a client with diabetes mellitus (DM) scheduled for surgery, it is essential to closely monitor blood glucose levels to prevent hypo- or hyperglycemia. Choice B is incorrect because giving the client a regular diet as ordered may not address the specific needs related to managing blood glucose levels in the perioperative period. Choice C is incorrect as abruptly stopping insulin 48 hours before surgery can lead to uncontrolled blood sugar levels, which is not recommended. Choice D is incorrect because holding the client's insulin on the morning of surgery can also disrupt blood sugar control, potentially leading to complications during the perioperative period.

2. A client with hypothyroidism is receiving levothyroxine therapy. The healthcare provider should monitor for which of the following signs of medication overdose?

• A. Bradycardia
• B. Weight gain
• C. Tachycardia
• D. Cold intolerance

Correct answer: C

Rationale: The correct answer is C: Tachycardia. Tachycardia is a sign of levothyroxine overdose, indicating that the dose may need to be adjusted. Bradycardia (Choice A) is a sign of hypothyroidism, not an overdose of levothyroxine. Weight gain (Choice B) and cold intolerance (Choice D) are also symptoms of hypothyroidism, not medication overdose.

3. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

• A. Acromegaly
• B. Type 1 diabetes mellitus
• C. Hypothyroidism
• D. Deficient growth hormone

Correct answer: A

Rationale: The correct answer is Acromegaly. Jemma's symptoms of large hands, hoarse voice, and snoring are indicative of acromegaly, a disorder caused by excessive growth hormone production. Acromegaly can lead to insulin resistance, which can result in hyperglycemia. Choice B, Type 1 diabetes mellitus, is unlikely in this case as the symptoms and presentation are more suggestive of acromegaly. Choice C, Hypothyroidism, typically presents with different symptoms such as weight gain, fatigue, and cold intolerance, not consistent with Jemma's symptoms. Choice D, Deficient growth hormone, would not lead to the signs and symptoms observed in Jemma, as her condition is characterized by excessive growth hormone production.

4. A client with DM is being taught about the importance of monitoring blood glucose levels. The nurse should instruct the client to monitor blood glucose:

• A. Before meals and at bedtime.
• B. Only after meals.
• C. Only in the morning.
• D. Only when feeling unwell.

Correct answer: A

Rationale: The correct answer is to monitor blood glucose levels before meals and at bedtime. This timing allows for a comprehensive understanding of how the body responds to food intake and to assess fasting glucose levels. Monitoring blood glucose only after meals (Choice B) may miss important pre-meal fluctuations. Checking glucose levels only in the morning (Choice C) overlooks the impact of meals throughout the day. Monitoring blood glucose only when feeling unwell (Choice D) is reactive and does not provide consistent data for managing diabetes effectively. Therefore, monitoring blood glucose before meals and at bedtime helps in maintaining good glucose control and preventing complications.

5. The patient expects that a type 1 diabetic may receive ____ of their morning dose of insulin preoperatively:

• A. 10-20%.
• B. 25-40%.
• C. 50-60%.
• D. 85-90%.

Correct answer: B

Rationale: It is common practice to administer 25-40% of the morning dose of insulin preoperatively to prevent hypoglycemia during surgery. Giving a lower percentage (A) may not provide sufficient glycemic control, while higher percentages (C, D) can increase the risk of hypoglycemia during the surgical procedure.

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