Nursing Elites

1. A client with osteoporosis is being discharged home. Which instruction should the nurse include in the discharge teaching?

• A. Avoid weight-bearing exercises.
• B. Take calcium supplements with meals.
• C. Limit vitamin D intake.
• D. Increase intake of caffeine-containing beverages.

Correct answer: B

Rationale: Taking calcium supplements with meals is a crucial instruction for a client with osteoporosis. Calcium absorption is enhanced when taken with food, and proper calcium intake is essential for managing osteoporosis effectively by promoting bone health and density. Avoiding weight-bearing exercises (Choice A) is incorrect because these exercises help improve bone strength. Limiting vitamin D intake (Choice C) is also incorrect as vitamin D is necessary for calcium absorption. Increasing caffeine intake (Choice D) is not recommended as caffeine can interfere with calcium absorption.

2. A 60-year-old man presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The presentation of a 60-year-old man with fatigue, polyuria, polydipsia, hyperglycemia, and ketonuria strongly suggests type 1 diabetes mellitus. Type 1 diabetes typically presents with acute symptoms due to absolute insulin deficiency, leading to hyperglycemia and ketonuria. Conversely, type 2 diabetes often presents more insidiously and is associated with relative insulin deficiency and insulin resistance. Diabetes insipidus, a condition characterized by excessive thirst and excretion of large amounts of dilute urine, is due to problems with antidiuretic hormone (ADH) and is not associated with hyperglycemia or ketonuria. Hyperthyroidism, while also presenting with symptoms like fatigue, does not typically manifest with hyperglycemia or ketonuria. Therefore, based on the clinical presentation and laboratory findings, the most likely diagnosis in this case is type 1 diabetes mellitus.

3. A patient with hypertension is prescribed lisinopril. What side effect should the nurse monitor for?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Bradycardia
• D. Constipation

Correct answer: A

Rationale: When a patient is prescribed lisinopril, an ACE inhibitor, the nurse should monitor for hyperkalemia. Lisinopril can cause hyperkalemia by decreasing aldosterone secretion, which leads to potassium retention in the body. Hyperkalemia is a potential side effect of ACE inhibitors and should be closely monitored, as it can have serious consequences such as affecting cardiac function.

4. A client in labor states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

• A. Administer oxygen via face mask.
• B. Notify the operating room team.
• C. Place the client in Trendelenburg.
• D. Administer a fluid bolus of 500 ml.

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to place the client in Trendelenburg position. This position helps alleviate pressure on the umbilical cord, preventing compression and ensuring continued blood flow to the fetus. Administering oxygen, notifying the operating room team, or administering a fluid bolus are not the initial priority actions in a cord prolapse situation.

5. The client with chronic kidney disease (CKD) is receiving hemodialysis. Which finding should be reported to the healthcare provider immediately?

• A. Blood pressure of 150/90 mm Hg.
• B. Weight gain of 2 pounds since the last dialysis session.
• C. Blood glucose level of 120 mg/dl.
• D. Potassium level of 6.5 mEq/L.

Correct answer: D

Rationale: A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, which can lead to severe cardiac complications like arrhythmias and cardiac arrest. Immediate medical intervention is necessary to lower potassium levels to prevent life-threatening outcomes in clients undergoing hemodialysis.

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