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. The client with type 2 DM is being instructed by the nurse about the importance of controlling blood glucose levels. The nurse should emphasize that uncontrolled blood glucose can lead to:

• A. Increased risk of heart disease and stroke.
• B. Improved wound healing.
• C. Reduced need for medication.
• D. Decreased risk of infection.

Correct answer: A

Rationale: Uncontrolled blood glucose levels are associated with an increased risk of cardiovascular complications, such as heart disease and stroke. High blood glucose levels can damage blood vessels over time, leading to atherosclerosis, which can increase the likelihood of heart disease and stroke. Improved wound healing (choice B) is not a consequence of uncontrolled blood glucose levels; in fact, high blood sugar levels can impair wound healing. Reduced need for medication (choice C) is inaccurate because uncontrolled blood glucose usually necessitates more medication to manage the condition. Decreased risk of infection (choice D) is also misleading as high blood glucose levels can compromise the immune system, making individuals more susceptible to infections.

3. The healthcare provider is monitoring a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following interventions should the healthcare provider include in the care plan?

• A. Encourage oral fluids
• B. Restrict fluid intake
• C. Administer potassium supplements
• D. Increase sodium intake

Correct answer: B

Rationale: The correct intervention for a client with SIADH is to restrict fluid intake. SIADH leads to water retention and dilution of sodium levels in the body, resulting in hyponatremia. Restricting fluid intake helps prevent further dilutional hyponatremia. Encouraging oral fluids (Choice A) would exacerbate the condition by further increasing fluid retention. Administering potassium supplements (Choice C) is not directly related to managing SIADH. Increasing sodium intake (Choice D) is contraindicated because it can worsen hyponatremia in clients with SIADH.

4. The healthcare provider is assessing a client with hypothyroidism. Which of the following symptoms would the provider expect to find?

• A. Weight loss
• B. Heat intolerance
• C. Bradycardia
• D. Diarrhea

Correct answer: C

Rationale: Bradycardia is a common symptom of hypothyroidism because the condition leads to a decreased metabolic rate. Weight loss (Choice A) is more commonly associated with hyperthyroidism, where the metabolic rate is increased. Heat intolerance (Choice B) is also more indicative of hyperthyroidism due to increased sensitivity to heat. Diarrhea (Choice D) is not a typical symptom of hypothyroidism; rather, constipation is more common due to the slow-down of the digestive system.

5. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

• A. Primary hypothyroidism
• B. Graves' disease
• C. Thyrotoxicosis
• D. Euthyroidism

Correct answer: A

Rationale: Levothyroxine is the preferred agent for primary hypothyroidism because it provides the necessary replacement of thyroid hormone in patients with deficient thyroid function. Choice B, Graves' disease, is an autoimmune disorder that causes hyperthyroidism and is typically treated with antithyroid medications or radioactive iodine. Choice C, thyrotoxicosis, refers to the clinical state resulting from excessive thyroid hormone action and is not typically treated with levothyroxine. Choice D, euthyroidism, describes a normal thyroid function and would not require treatment with levothyroxine.

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