Nursing Elites

1. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?

• A. The best time for me to exercise is every afternoon.
• B. The best time for me to exercise is right after I eat.
• C. The best time for me to exercise is after breakfast.
• D. The best time for me to exercise is after my morning snack.

Correct answer: A

Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.

2. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

• A. Be sure to take glipizide 30 minutes before meals.
• B. Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.
• C. You won't need to check your blood glucose level after you start taking glipizide.
• D. Take glipizide after a meal to prevent heartburn.

Correct answer: A

Rationale: Glipizide should be taken 30 minutes before meals to maximize its glucose-lowering effect.

3. What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?

• A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
• B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
• C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
• D. It regulates the threshold for water reabsorption in the kidneys.

Correct answer: C

Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.

4. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

• A. Integumentary inspection for the presence of brown spots on the lower extremities.
• B. Observation for paleness of the lower extremities.
• C. Observation for blanching of the feet after the legs are elevated for 60 seconds.
• D. Palpation for increased pulse volume in the arteries of the lower extremities.

Correct answer: D

Rationale: In a patient with impaired peripheral arterial circulation, clinical nursing assessment should include integumentary inspection for the presence of brown spots, observation for paleness of the lower extremities, and observation for blanching of the feet after the legs are elevated for 60 seconds. Palpation for increased pulse volume in the arteries of the lower extremities is not consistent with impaired circulation, as pulses are typically diminished in this condition. Therefore, palpation for increased pulse volume is not relevant to the assessment of impaired peripheral arterial circulation.

5. The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select one that does not apply.

• A. Place the solution on an IV pump at the prescribed rate.
• B. Monitor blood glucose every twelve (12) hours.
• C. Weigh the client weekly, first thing in the morning.
• D. Change the IV tubing every three (3) days.

Correct answer: D

Rationale: Precautions for clients receiving TPN include placing the solution on an IV pump to control the rate, monitoring blood glucose levels to detect hyperglycemia, and monitoring intake and output to assess fluid balance. Changing the IV tubing every three days is not a standard precaution for clients receiving TPN via a subclavian line.

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