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. The healthcare provider is monitoring a client with diabetic ketoacidosis (DKA). Which of the following laboratory findings would be expected?

• A. Decreased blood glucose levels
• B. Decreased urine ketones
• C. Increased serum bicarbonate
• D. Increased anion gap

Correct answer: D

Rationale: In diabetic ketoacidosis (DKA), there is an excess of ketone bodies produced due to the breakdown of fatty acids for energy, leading to metabolic acidosis. An increased anion gap is a characteristic laboratory finding in DKA. The increased anion gap is a result of the accumulation of ketoacids and lactic acid in the blood, contributing to metabolic acidosis. Therefore, the correct answer is an increased anion gap. Choices A, B, and C are incorrect because in DKA, blood glucose levels are typically elevated, urine ketones are increased due to the breakdown of fatty acids, and serum bicarbonate is usually decreased as it is consumed in an attempt to buffer the acidosis.

3. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client's need for additional teaching when the client states:

• A. If I have hypoglycemia, I should eat some sugar, not dextrose.
• B. The drug makes my pancreas release more insulin.
• C. I should never take insulin while I'm taking this drug.
• D. It's best if I take the drug with the first bite of a meal.

Correct answer: B

Rationale: The correct answer is B. Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing carbohydrate absorption in the intestine, not by stimulating insulin release. Therefore, the client would need additional teaching if they state that the drug makes their pancreas release more insulin (Choice B). Choices A, C, and D are incorrect. Choice A is incorrect because during hypoglycemia, it is recommended to consume glucose or dextrose to rapidly raise blood sugar levels. Choice C is incorrect because insulin therapy may still be needed in some cases, even when taking acarbose. Choice D is incorrect because acarbose should be taken at the start of a meal to help reduce postprandial blood glucose levels.

4. When should a new nurse graduate consider applying for a position as a nurse manager?

• A. When she is comfortable in her current position
• B. When she begins mentoring other new nurses
• C. As soon as a position opens
• D. When she has developed leadership and clinical expertise

Correct answer: D

Rationale: A new nurse graduate should consider applying for a position as a nurse manager when she has developed leadership and clinical expertise. Option A, 'When she is comfortable in her current position,' is incorrect as comfort in the current position may not necessarily align with the skills required for a managerial role. Option B, 'When she begins mentoring other new nurses,' is not a definitive indicator of readiness for a managerial position. Option C, 'As soon as a position opens,' does not take into account the necessary skills and experience required for a nurse manager role. Therefore, the best time to consider applying for a nurse manager position is after developing the required leadership and clinical expertise.

5. A client with type 2 diabetes mellitus is being discharged after receiving initial treatment. What should the nurse emphasize as a crucial instruction?

• A. Take insulin as prescribed, even if you are not eating.
• B. Avoid all forms of physical exercise to prevent hypoglycemia.
• C. Monitor blood glucose levels regularly and report any changes.
• D. Stop taking oral antidiabetic medication if your blood glucose levels are normal.

Correct answer: C

Rationale: Monitoring blood glucose levels regularly is a critical aspect of managing type 2 diabetes mellitus. This allows the individual to track their blood sugar levels, understand the effectiveness of the treatment plan, and detect any fluctuations promptly. Option A is incorrect because insulin should be taken based on a prescribed schedule that correlates with meals to prevent hypoglycemia or hyperglycemia. Option B is incorrect as physical exercise is beneficial for managing diabetes but should be done cautiously with adjustments in insulin or food intake. Option D is incorrect because discontinuing oral antidiabetic medications without healthcare provider guidance can lead to uncontrolled blood glucose levels.

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