Nursing Elites

1. A client with type 2 diabetes mellitus is being educated on foot care. Which of the following instructions should the nurse provide?

• A. Soak your feet in warm water daily.
• B. Avoid going barefoot to protect your feet.
• C. Inspect your feet daily for any cuts or sores.
• D. Avoid using a heating pad to warm your feet if they are cold.

Correct answer: C

Rationale: The correct instruction for a client with type 2 diabetes mellitus regarding foot care is to inspect their feet daily for any cuts or sores. This practice helps in early detection of potential issues like cuts, sores, or infections, which can be challenging to heal due to poor circulation in diabetes. Choice A is incorrect because soaking feet in hot water can lead to burns or skin damage, especially for individuals with diabetes who may have reduced sensation. Choice B is incorrect because going barefoot increases the risk of injuries and infections for individuals with diabetes. Choice D is incorrect because using a heating pad can also impair sensation, increasing the risk of burns or injuries for diabetic individuals.

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. Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

• A. Hypoglycemia.
• B. Hyponatremia.
• C. Ketonuria.
• D. Polyphagia.

Correct answer: B

Rationale: Clinical manifestations of type 1 diabetes mellitus include hypoglycemia, ketonuria, and polyphagia. Hyponatremia is not typically associated with type 1 diabetes mellitus; it is more commonly linked with other conditions such as syndrome of inappropriate antidiuretic hormone secretion (SIADH) or heart failure. Therefore, the correct answer is B: Hyponatremia.

4. A client with type 1 DM is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should prioritize which action?

• A. Administering intravenous fluids.
• B. Administering oral glucose.
• C. Administering a fever-reducing medication.
• D. Administering oxygen therapy.

Correct answer: A

Rationale: Administering intravenous fluids is the priority in treating DKA for several reasons. DKA is characterized by severe dehydration and electrolyte imbalances due to hyperglycemia. IV fluids help to correct dehydration, restore electrolyte balance, and decrease blood glucose levels. Administering oral glucose (Choice B) would be contraindicated in DKA as the primary issue is high blood glucose levels. Administering a fever-reducing medication (Choice C) is not the priority in managing DKA. Administering oxygen therapy (Choice D) may be necessary in some cases, but correcting dehydration and electrolyte imbalances take precedence in the management of DKA.

5. The healthcare provider is assessing a client with Addison's disease. Which of the following symptoms is consistent with this condition?

• A. Hypertension
• B. Hyperglycemia
• C. Hyperpigmentation
• D. Weight gain

Correct answer: C

Rationale: Hyperpigmentation is a characteristic symptom of Addison's disease. In Addison's disease, there is a decrease in cortisol production, leading to an increase in adrenocorticotropic hormone (ACTH) secretion by the pituitary gland. Excess ACTH can stimulate melanocytes, resulting in hyperpigmentation. Choices A, B, and D are not typically associated with Addison's disease. Hypertension is more commonly associated with conditions involving excess cortisol production, such as Cushing's syndrome. Hyperglycemia may occur in diabetes mellitus but is not a hallmark of Addison's disease. Weight loss, rather than weight gain, is a common symptom of Addison's disease due to decreased cortisol levels.

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