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 newly diagnosed with DM asks a nurse why it is necessary to monitor blood glucose levels so often. The nurse's best response would be:

• A. It helps to adjust insulin doses more precisely.
• B. It helps to prevent complications of diabetes.
• C. It helps to identify the best diet for you.
• D. It helps to reduce the need for medications.

Correct answer: B

Rationale: Monitoring blood glucose levels frequently is crucial for preventing complications in diabetes. By keeping a close eye on blood glucose levels, healthcare providers can intervene in a timely manner if levels are out of range, thus reducing the risk of long-term complications such as nerve damage, kidney disease, and vision problems. Choices A, C, and D are incorrect because while monitoring blood glucose levels may indirectly contribute to adjusting insulin doses, identifying the best diet, and reducing the need for medications, the primary purpose is to prevent complications through timely interventions.

3. Nurse Noemi administers glucagon to her diabetic client and then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

• A. Oral anticoagulants
• B. Anabolic steroids
• C. Beta-adrenergic blockers
• D. Thiazide diuretics

Correct answer: A

Rationale: The correct answer is A: Oral anticoagulants. Glucagon may enhance the anticoagulant effect of oral anticoagulants, increasing the risk of bleeding. This interaction can be dangerous for the patient, leading to serious complications. Choices B, C, and D are incorrect because anabolic steroids, beta-adrenergic blockers, and thiazide diuretics do not typically interact adversely with glucagon. It is crucial for healthcare providers to be aware of potential drug interactions to ensure patient safety and optimal outcomes.

4. A client with Addison's disease is receiving corticosteroid therapy. The nurse should monitor the client for which of the following potential side effects?

• A. Hypoglycemia
• B. Hypertension
• C. Weight loss
• D. Hyperkalemia

Correct answer: B

Rationale: When a client with Addison's disease is receiving corticosteroid therapy, the nurse should monitor for hypertension as a potential side effect. Corticosteroids can lead to hypertension by causing fluid retention and increased blood volume. Hypoglycemia (Choice A) is not a common side effect of corticosteroid therapy; instead, hyperglycemia is more likely. Weight loss (Choice C) is not a typical side effect of corticosteroid therapy; in fact, weight gain is more common due to fluid retention and increased appetite. Hyperkalemia (Choice D) is a potential side effect of Addison's disease itself due to adrenal insufficiency, but it is not directly caused by corticosteroid therapy.

5. In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in:

• A. Serum glucose level.
• B. Hair loss.
• C. Bone mineralization.
• D. Menstrual flow.

Correct answer: A

Rationale: The correct answer is A: Serum glucose level. In Cushing's syndrome, there is excess cortisol production which can lead to hyperglycemia. Successful treatment of Cushing's syndrome aims to normalize cortisol levels, resulting in a decline in serum glucose levels. Choice B, hair loss, is not specifically associated with Cushing's syndrome or its treatment. Choice C, bone mineralization, is often compromised in Cushing's syndrome due to the effects of excess cortisol on bones; however, successful treatment would aim to improve bone health rather than decline it. Choice D, menstrual flow, is not directly linked to Cushing's syndrome or its treatment, so a decline in menstrual flow would not be an expected outcome of successful treatment.

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