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. The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present?

• A. Weight loss
• B. Flat neck and hand veins
• C. An increase in blood pressure
• D. A decreased central venous pressure (CVP)

Correct answer: C

Rationale: An increase in blood pressure is a common sign of fluid volume excess in clients with congestive heart failure due to the increased amount of fluid in the vascular system. Weight loss (Choice A) is not typically associated with fluid volume excess. Flat neck and hand veins (Choice B) are signs of fluid volume deficit, not excess. A decreased central venous pressure (CVP) (Choice D) is not expected in a client with fluid volume excess.

3. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, Nurse Tina assesses the client, who now has nausea, a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

• A. Diabetic ketoacidosis
• B. Thyroid crisis
• C. Hypoglycemia
• D. Tetany

Correct answer: B

Rationale: The correct answer is B: Thyroid crisis. Thyroid crisis, also known as thyroid storm, is a life-threatening condition that can occur after a thyroidectomy. Symptoms include high fever, tachycardia, extreme restlessness, and other signs of severe hyperthyroidism. Diabetic ketoacidosis (choice A) is a complication of diabetes characterized by hyperglycemia, ketosis, and acidosis, not typically seen post-thyroidectomy. Hypoglycemia (choice C) is low blood sugar levels and would not present with the symptoms described. Tetany (choice D) is a condition of involuntary muscle spasms due to low calcium levels and is not directly related to the symptoms observed in this scenario.

4. A client with diabetes mellitus is receiving an oral antidiabetic medication. The nurse should monitor for which of the following adverse effects?

• A. Weight gain
• B. Hypoglycemia
• C. Hyperglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Hypoglycemia. When a client with diabetes mellitus is taking oral antidiabetic medication, the nurse should closely monitor for hypoglycemia, which is a common adverse effect. Hypoglycemia occurs when the blood sugar levels drop below normal range, leading to symptoms like confusion, shakiness, and sweating. Weight gain (Choice A) is not a typical adverse effect of oral antidiabetic medications. Hyperglycemia (Choice C) is the opposite of the desired effect of antidiabetic medications, which aim to lower blood sugar levels. Bradycardia (Choice D) is not directly associated with oral antidiabetic medications; it refers to a slow heart rate.

5. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

• A. Acromegaly
• B. Type 1 diabetes mellitus
• C. Hypothyroidism
• D. Deficient growth hormone

Correct answer: A

Rationale: The correct answer is Acromegaly. Jemma's symptoms of large hands, hoarse voice, and snoring are indicative of acromegaly, a disorder caused by excessive growth hormone production. Acromegaly can lead to insulin resistance, which can result in hyperglycemia. Choice B, Type 1 diabetes mellitus, is unlikely in this case as the symptoms and presentation are more suggestive of acromegaly. Choice C, Hypothyroidism, typically presents with different symptoms such as weight gain, fatigue, and cold intolerance, not consistent with Jemma's symptoms. Choice D, Deficient growth hormone, would not lead to the signs and symptoms observed in Jemma, as her condition is characterized by excessive growth hormone production.

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