Nursing Elites

1. A client with type 1 DM is taught to take NPH and regular insulin every morning. The nurse should provide which instructions to the client?

• A. Take the NPH insulin first, then the regular insulin.
• B. Take the regular insulin first, then the NPH insulin.
• C. It does not matter which insulin is drawn up first.
• D. Contact the healthcare provider if the order for insulin is unclear.

Correct answer: B

Rationale: The correct answer is to take the regular insulin first, then the NPH insulin. Regular insulin should be drawn up before NPH insulin to prevent contamination of the regular insulin vial with the longer-acting insulin. Choice A is incorrect as it suggests taking the NPH insulin first, which is not the recommended practice. Choice C is incorrect because the order of drawing up insulin does matter to prevent contamination. Choice D is not the most appropriate action in this scenario, as the nurse should provide clear instructions to the client based on best practices.

2. A client with type 2 diabetes mellitus is taking metformin. The nurse should monitor the client for which of the following potential side effects?

• A. Lactic acidosis
• B. Hypokalemia
• C. Hyperglycemia
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A: Lactic acidosis. Metformin, a common medication for type 2 diabetes mellitus, can lead to lactic acidosis, particularly in individuals with renal impairment or other predisposing factors. Monitoring for signs and symptoms of lactic acidosis, such as muscle pain, weakness, trouble breathing, dizziness, and slow or irregular heartbeat, is crucial when a client is taking metformin. Choice B, hypokalemia, is not a common side effect of metformin. Choice C, hyperglycemia, is contrary to the intended effect of metformin, which is to lower blood glucose levels. Choice D, weight gain, is not typically associated with metformin use; in fact, metformin may even contribute to weight loss in some individuals.

3. The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?

• A. Serum calcium.
• B. Serum phosphorus.
• C. Serum potassium.
• D. Serum sodium.

Correct answer: C

Rationale: During episodes of vomiting and diarrhea, there is a risk of significant potassium loss, leading to potential electrolyte imbalances. Monitoring serum potassium levels is crucial in this situation to assess and manage any abnormalities promptly. Serum calcium (Choice A) is not typically affected by vomiting and diarrhea. Serum phosphorus (Choice B) levels are not commonly altered by these symptoms. Serum sodium (Choice D) may be affected in severe cases of dehydration, but potassium monitoring is a higher priority due to its potential for rapid depletion in vomiting and diarrhea.

4. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:

• A. Prefers to take insulin orally.
• B. Has type 2 diabetes.
• C. Has type 1 diabetes.
• D. Is pregnant and has type 2 diabetes.

Correct answer: B

Rationale: Oral antidiabetic agents are specifically designed for type 2 diabetes mellitus. Type 1 diabetes requires insulin therapy as the primary treatment due to the absence of endogenous insulin production. Therefore, these medications are not effective for individuals with type 1 diabetes like the male client in this scenario. Choice A is incorrect as oral antidiabetic agents are not about preference but rather about treatment efficacy. Choice D is incorrect as being pregnant does not impact the effectiveness of oral antidiabetic agents; they are primarily indicated for type 2 diabetes.

5. A healthcare professional caring for a client who has been receiving intravenous diuretics suspects that the client is experiencing a deficient fluid volume. Which assessment finding would the healthcare professional note in a client with this condition?

• A. Lung congestion
• B. Decreased hematocrit
• C. Increased blood pressure
• D. Decreased central venous pressure (CVP)

Correct answer: D

Rationale: Decreased central venous pressure (CVP) is the correct assessment finding in a client with deficient fluid volume. This is because a decrease in CVP indicates reduced blood volume returning to the heart, which is consistent with hypovolemia. Lung congestion (Choice A) would be more indicative of fluid volume excess, not deficiency. Decreased hematocrit (Choice B) may be seen in conditions such as anemia but is not specific to deficient fluid volume. Increased blood pressure (Choice C) is not typically associated with deficient fluid volume; in fact, hypovolemia often leads to decreased blood pressure.

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