Nursing Elites

1. 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.

2. The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present?

• A. Weight loss
• B. Flat neck and hand veins
• C. An increase in blood pressure
• D. A decreased central venous pressure (CVP)

Correct answer: C

Rationale: An increase in blood pressure is a common sign of fluid volume excess in clients with congestive heart failure due to the increased amount of fluid in the vascular system. Weight loss (Choice A) is not typically associated with fluid volume excess. Flat neck and hand veins (Choice B) are signs of fluid volume deficit, not excess. A decreased central venous pressure (CVP) (Choice D) is not expected in a client with fluid volume excess.

3. Which instruction about insulin administration should Nurse Kate give to a client?

• A. Always follow the same order when drawing up different insulins into the syringe.
• B. Shake the vials before withdrawing the insulin.
• C. Store unopened vials of insulin in the refrigerator at recommended temperatures.
• D. Discard the intermediate-acting insulin if it appears cloudy.

Correct answer: A

Rationale: The correct answer is A. Consistently following the same order when drawing up different insulins helps to prevent medication errors. Option B is incorrect because shaking insulin vials could cause bubbles to form, leading to inaccurate dosing. Option C is incorrect as insulin should be stored in the refrigerator, not the freezer, to maintain its effectiveness. Option D is incorrect because cloudy appearance in intermediate-acting insulin may indicate the presence of insulin crystals, which can affect its potency, but this does not necessarily mean it should be discarded without consulting a healthcare provider.

4. The client with DM who is taking insulin develops a fever and becomes confused. Which action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer a fever-reducing medication.
• C. Give the client fluids to drink.
• D. Notify the health care provider.

Correct answer: A

Rationale: In a client with diabetes mellitus (DM) taking insulin, the development of fever and confusion may indicate hyperglycemia or diabetic ketoacidosis. Checking the blood glucose level is the priority action in this situation. This will help determine if the symptoms are related to high blood sugar levels, guiding further interventions. Administering a fever-reducing medication (choice B) addresses only the symptom of fever and does not address the underlying cause. Providing fluids to drink (choice C) is important but should come after addressing the potential hyperglycemia or diabetic ketoacidosis. Notifying the health care provider (choice D) can be important, but immediate action to evaluate and manage the client's condition should precede contacting the provider.

5. What is the lowest fasting plasma glucose level suggestive of a diagnosis of DM?

• A. 90 mg/dl.
• B. 115 mg/dl.
• C. 126 mg/dl.
• D. 180 mg/dl.

Correct answer: C

Rationale: A fasting plasma glucose level of 126 mg/dl or higher is diagnostic of diabetes mellitus. Choice A (90 mg/dl) is too low to indicate diabetes. Choice B (115 mg/dl) is also below the diagnostic threshold for diabetes. Choice D (180 mg/dl) is above the diagnostic threshold and would indicate uncontrolled diabetes, not the lowest level suggestive of a diagnosis.

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