Nursing Elites

1. A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which of the following interventions should be the nurse's priority?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct answer is to start an intravenous line and infuse normal saline. In diabetic ketoacidosis (DKA), the priority intervention is fluid resuscitation with normal saline to restore intravascular volume and improve perfusion. Administering insulin without first addressing dehydration and electrolyte imbalances can lead to further complications. Monitoring serum potassium levels and obtaining an arterial blood gas (ABG) are important aspects of DKA management but come after initial fluid resuscitation.

2. A client with type 1 diabetes mellitus is experiencing hypoglycemia. What should the nurse instruct the client to do?

• A. Administer insulin immediately
• B. Consume 15 grams of simple carbohydrates
• C. Drink plenty of water
• D. Avoid eating until symptoms resolve

Correct answer: B

Rationale: When a client with type 1 diabetes mellitus experiences hypoglycemia, the nurse should instruct them to consume 15 grams of simple carbohydrates. This is the recommended initial treatment for hypoglycemia as it helps quickly raise blood sugar levels to alleviate symptoms and prevent complications. Administering insulin immediately (Choice A) would further lower blood sugar levels, worsening the hypoglycemia. Drinking plenty of water (Choice C) and avoiding eating until symptoms resolve (Choice D) are not appropriate actions for treating hypoglycemia as they do not address the immediate need to raise blood sugar levels.

3. A client with Addison's disease is being educated on managing the condition. Which of the following statements indicates a need for further teaching?

• A. I should carry an emergency kit with hydrocortisone at all times.
• B. I need to increase my sodium intake during hot weather.
• C. I can skip my medication if I feel well.
• D. I should avoid stress as much as possible.

Correct answer: C

Rationale: The correct answer is C. Clients with Addison's disease should not skip their medication, even if they feel well, as consistent medication is necessary to manage the condition. Choice A is correct as carrying an emergency kit with hydrocortisone is essential for managing potential adrenal crises. Choice B is correct as increasing sodium intake during hot weather helps prevent electrolyte imbalances. Choice D is correct as stress can trigger adrenal crisis in individuals with Addison's disease, so stress management is crucial.

4. Which of the following statements should be included in the teaching to a client about a do-not-resuscitate order (DNR)?

• A. When a heart ceases to beat, the client is pronounced clinically dead.
• B. Physicians are required to write DNR orders.
• C. A DNR order can be written after discussion with the client and family.
• D. A court decision is needed for a DNR.

Correct answer: C

Rationale: The correct statement to include in teaching a client about a do-not-resuscitate (DNR) order is that it can be written after discussion with the client and family. This involves ensuring that the client and their family understand the implications and make an informed decision. Choice A is incorrect as pronouncing clinical death is not directly related to discussing a DNR order. Choice B is incorrect as while physicians typically write DNR orders, it is not a strict requirement. Choice D is incorrect as a court decision is not typically required for a DNR order; it is a decision made by the client with input from healthcare providers and family members.

5. Which of the following symptoms would be most concerning in a client with diabetes insipidus?

• A. Polydipsia
• B. Polyuria
• C. Nocturia
• D. Hypertension

Correct answer: D

Rationale: In a client with diabetes insipidus, excessive thirst (polydipsia) and excessive urination (polyuria) are expected symptoms due to the inability to concentrate urine, leading to dilute urine production. Nocturia, waking up at night to urinate, is also common. However, hypertension is not a typical symptom of diabetes insipidus. The correct answer is D because hypertension may indicate a complication such as dehydration or electrolyte imbalances, which would require further assessment in a client with diabetes insipidus.

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