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. The client with newly diagnosed diabetes mellitus is receiving education from the nurse on managing blood glucose levels. Which statement indicates a need for further teaching?

• A. I will monitor my blood glucose levels regularly.
• B. I can eat whatever I want as long as I take my medication.
• C. I should exercise regularly to help control my blood sugar.
• D. I will rotate my injection sites to avoid tissue damage.

Correct answer: B

Rationale: Choice B indicates a need for further teaching because it suggests that the client can eat whatever they want as long as they take their medication, which is incorrect. Clients with diabetes mellitus need to follow a healthy and balanced diet in addition to taking their medication to effectively manage blood glucose levels. Choices A, C, and D are correct statements for managing diabetes. Monitoring blood glucose levels regularly, engaging in regular exercise to help control blood sugar, and rotating injection sites to avoid tissue damage are all important aspects of diabetes management.

3. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should Nurse Hans recognize as an adverse drug effect?

• A. Dysuria
• B. Leg cramps
• C. Tachycardia
• D. Blurred vision

Correct answer: C

Rationale: Tachycardia is a potential adverse effect of levothyroxine, indicating overmedication. Dysuria (painful urination) is not typically associated with levothyroxine. Leg cramps are not a common adverse effect of levothyroxine. Blurred vision is not a typical adverse effect of levothyroxine; instead, it may be a sign of other eye-related conditions or medication side effects.

4. What is the most common cause of hyperaldosteronism?

• A. Excessive sodium intake
• B. A pituitary adenoma
• C. Deficient potassium intake
• D. An adrenal adenoma

Correct answer: D

Rationale: An adrenal adenoma is the most common cause of primary hyperaldosteronism. Hyperaldosteronism is typically caused by an adrenal adenoma, a benign tumor in the adrenal gland that leads to excessive aldosterone production. Excessive sodium intake (Choice A) does not directly cause hyperaldosteronism. Pituitary adenoma (Choice B) is associated with conditions like Cushing's disease, not hyperaldosteronism. Deficient potassium intake (Choice C) can lead to hypokalemia but is not a common cause of hyperaldosteronism.

5. The client with type 1 DM asks why it is necessary to rotate injection sites when managing insulin therapy. The nurse's best response is:

• A. It helps prevent skin irritation.
• B. It helps prevent scar tissue buildup.
• C. It ensures more consistent insulin absorption.
• D. It makes the injections less painful.

Correct answer: C

Rationale: Rotating injection sites is necessary to ensure more consistent insulin absorption. This practice helps maintain stable blood glucose levels by preventing the formation of lipohypertrophy (fatty lumps under the skin) at injection sites. Choices A and B are incorrect as the primary purpose of rotating injection sites is not focused on preventing skin irritation or scar tissue buildup. While rotating injection sites may contribute to reducing pain over time, the primary benefit is the consistency in insulin absorption to support glycemic control, making choice D less relevant.

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