Nursing Elites

1. A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic episodes and a glycosylated hemoglobin (A1C) of 10%. Insulin glargine 10 units subcutaneously once a day at bedtime and a sliding scale of insulin aspart every 6 hours are prescribed. What actions should the nurse include in this client's plan of care?

• A. Teach subcutaneous injection technique, site rotation, and insulin management
• B. Coordinate carbohydrate-controlled meals at consistent times and intervals
• C. Review with the client proper foot care and prevention of injury
• D. All of the above

Correct answer: D

Rationale: Effective diabetes management involves comprehensive care, including proper foot care, insulin administration technique, and maintaining carbohydrate consistency with meals. All of these interventions are critical in reducing hyperglycemic episodes and managing diabetes.

2. A mother reports that she has been applying triple antibiotic ointment for her son's athlete's foot for two days with no improvement. What should the nurse instruct?

• A. Continue using the ointment and keep the area clean.
• B. Stop using the ointment and encourage the feet to be dried completely.
• C. Apply a different antifungal medication instead.
• D. Reapply the ointment twice a day for a longer period.

Correct answer: B

Rationale: Antibiotic ointment is ineffective against athlete's foot, which is a fungal infection. The nurse should instruct the mother to stop using the ointment and ensure the feet are dried properly, as moisture exacerbates fungal infections. Applying a different antifungal medication is a valid option, but addressing the moisture issue by drying the feet completely is the immediate priority. Continuing to use the antibiotic ointment or reapplying it for a longer period will not treat the fungal infection effectively.

3. A client with acute pancreatitis is admitted with severe, piercing abdominal pain and an elevated serum amylase. Which additional information is the client most likely to report to the nurse?

• A. Pain radiates to the back
• B. Nausea and vomiting without relief
• C. Abdominal pain decreases when lying supine
• D. Abdominal pain is worse after eating

Correct answer: D

Rationale: The correct answer is D. In acute pancreatitis, abdominal pain typically worsens after eating due to the stimulation of the pancreas to release enzymes that irritate the inflamed tissues. Pain relief when lying supine is uncommon and usually exacerbates discomfort. While nausea and vomiting are common symptoms, they are not as indicative of changes in pain intensity. Pain radiating to the back is characteristic but does not specifically relate to exacerbation post-eating.

4. A client reports unilateral leg swelling after a long flight. What complication is the nurse most concerned about?

• A. Monitor for signs of a pulmonary embolism.
• B. Assess for signs of dehydration.
• C. Monitor for signs of compartment syndrome.
• D. Check the client’s oxygen saturation levels.

Correct answer: A

Rationale: The correct answer is A. Unilateral leg swelling following a long flight may indicate a pulmonary embolism, which is a life-threatening complication requiring immediate attention. Pulmonary embolism occurs when a blood clot travels to the lungs, potentially blocking blood flow and leading to serious complications. Choices B, C, and D are incorrect because dehydration, compartment syndrome, and oxygen saturation levels are not typically associated with unilateral leg swelling after a long flight. While dehydration can cause leg cramps, compartment syndrome is more commonly associated with trauma or injury, and oxygen saturation levels are not the primary concern in this scenario.

5. A client is scheduled for a colonoscopy and has been prescribed a bowel preparation. What is the most important instruction for the nurse to provide?

• A. Eat a low-fiber diet the day before the procedure
• B. Drink clear liquids 24 hours before the procedure
• C. Take the entire bowel preparation as directed
• D. Avoid all solid foods 12 hours before the procedure

Correct answer: C

Rationale: The most important instruction for the nurse to provide to a client scheduled for a colonoscopy and prescribed a bowel preparation is to take the entire bowel preparation as directed. Completing the entire bowel preparation as prescribed is crucial to ensure the colon is properly cleansed for the colonoscopy. Incomplete bowel prep can interfere with the visualization of the colon, leading to inaccurate results. Choices A, B, and D are important but not as crucial as ensuring the complete intake of the bowel preparation for an effective procedure.

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