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. A client with DM is preparing for a foot care exam. The nurse should advise the client to:

• A. Wear loose-fitting shoes to protect the feet.
• B. Apply lotion to the tops and bottoms of the feet to keep the skin moist.
• C. Avoid using a heating pad to prevent burns on the feet.
• D. Avoid using sharp instruments to trim the toenails.

Correct answer: D

Rationale: The correct answer is to advise the client to avoid using sharp instruments to trim the toenails. This is crucial because using sharp instruments can lead to injuries such as cuts or wounds, increasing the risk of infections, especially in clients with diabetes who have decreased sensation in their feet. Choice A is incorrect because tight shoes can restrict circulation and increase the risk of pressure sores. Choice B is incorrect because applying lotion between the toes can create a moist environment, leading to fungal infections. Choice C is incorrect because using a heating pad can lead to burns, which can go unnoticed due to decreased sensation in diabetic feet.

3. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:

• A. I.M. or subcutaneous glucagon.
• B. I.V. bolus of dextrose 50%.
• C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
• D. 10 U of fast-acting insulin.

Correct answer: C

Rationale: For a conscious client with hypoglycemia, the initial treatment should involve administering 15 to 20 g of a fast-acting carbohydrate, such as orange juice. This helps rapidly raise the client's blood glucose levels. Choices A and D are incorrect as administering glucagon or fast-acting insulin is not the first-line treatment for hypoglycemia in a conscious client. Choice B, an I.V. bolus of dextrose 50%, is a more invasive and aggressive intervention that is not typically indicated for a conscious client with hypoglycemia.

4. A client with hyperaldosteronism is at risk for which of the following electrolyte imbalances?

• A. Hyperkalemia
• B. Hyponatremia
• C. Hypokalemia
• D. Hypercalcemia

Correct answer: C

Rationale: In hyperaldosteronism, there is an excessive secretion of aldosterone, a hormone that promotes potassium excretion in the kidneys. This leads to low potassium levels in the blood, known as hypokalemia. Therefore, the correct answer is hypokalemia (Choice C). Hyperkalemia (Choice A) is the opposite condition, where there is high potassium levels in the blood and is not typically associated with hyperaldosteronism. Hyponatremia (Choice B) is a low sodium level, which is not directly related to aldosterone function. Hypercalcemia (Choice D) is an elevated calcium level and is not typically a direct result of hyperaldosteronism.

5. When caring for a female client with a history of hypoglycemia, Nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

• A. Sulfisoxazole (Gantrisin)
• B. Mexiletine (Mexitil)
• C. Prednisone (Orasone)
• D. Lithium carbonate (Lithobid)

Correct answer: A

Rationale: The correct answer is A, Sulfisoxazole (Gantrisin). Sulfisoxazole is known to potentiate hypoglycemia, making it unsafe for clients with a history of hypoglycemia. Choice B, Mexiletine, is a medication used to treat certain heart rhythm problems and is not associated with hypoglycemia. Choice C, Prednisone, is a corticosteroid and does not potentiate hypoglycemia. Choice D, Lithium carbonate, is commonly used to treat bipolar disorder and does not typically potentiate hypoglycemia. Therefore, the drug that Nurse Ruby should avoid in this case is Sulfisoxazole (Gantrisin) to prevent worsening the client's hypoglycemic condition.

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