Nursing Elites

1. A client with type 2 DM is being treated with metformin (Glucophage). The nurse should include which instruction when teaching the client about this medication?

• A. Take the medication with meals.
• B. Take the medication on an empty stomach.
• C. Take the medication before bedtime.
• D. Avoid taking the medication if you miss a meal.

Correct answer: A

Rationale: The correct instruction for a client taking metformin (Glucophage) is to take the medication with meals. This helps reduce gastrointestinal side effects and improves absorption. Choice B is incorrect because taking metformin on an empty stomach can increase the risk of side effects. Choice C is incorrect as there is no specific recommendation to take metformin before bedtime. Choice D is incorrect as missing a meal should not lead to avoiding the medication, but the client should take it with the next meal as prescribed.

2. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

• A. Serum potassium level
• B. Serum sodium level
• C. Arterial blood gas (ABG) values
• D. Serum osmolarity

Correct answer: D

Rationale: Serum osmolarity is the most important laboratory test for confirming hyperosmolar hyperglycemic nonketotic syndrome (HHNS). HHNS is characterized by severe hyperglycemia and dehydration without ketoacidosis. Elevated serum osmolarity indicates increased solute concentration in the blood, which is a hallmark of HHNS. Serum potassium level (Choice A) is important in conditions like diabetic ketoacidosis rather than HHNS. Serum sodium level (Choice B) may be affected in HHNS but is not the primary test for confirming the disorder. Arterial blood gas (ABG) values (Choice C) are more useful in assessing acid-base status, which is not the primary concern in HHNS.

3. A client with hypothyroidism is at risk for which of the following complications?

• A. Thyroid storm
• B. Myxedema coma
• C. Cushing's syndrome
• D. Diabetic ketoacidosis

Correct answer: B

Rationale: Myxedema coma is a severe, life-threatening complication that can occur in individuals with untreated or inadequately treated hypothyroidism. It is characterized by extreme hypothyroidism leading to decreased mental status, hypothermia, bradycardia, and respiratory depression. Thyroid storm (Choice A) is a severe complication of hyperthyroidism, not hypothyroidism. Cushing's syndrome (Choice C) results from prolonged exposure to high levels of cortisol, not related to hypothyroidism. Diabetic ketoacidosis (Choice D) is a complication of uncontrolled diabetes, not directly associated with hypothyroidism.

4. Nurse Wayne is aware that a positive Chvostek's sign indicates:

• A. Hypocalcemia
• B. Hyponatremia
• C. Hypokalemia
• D. Hypermagnesemia

Correct answer: A

Rationale: A positive Chvostek's sign indicates hypocalcemia. This sign is elicited by tapping the facial nerve anterior to the ear, resulting in facial muscle twitching due to increased neuromuscular irritability from low calcium levels. Hyponatremia (Choice B) is characterized by low sodium levels, but it does not present with Chvostek's sign. Hypokalemia (Choice C) is low potassium levels, and hypermagnesemia (Choice D) is high magnesium levels, neither of which are associated with Chvostek's sign.

5. Which of the following symptoms would be most concerning in a client with diabetes insipidus?

• A. Polydipsia
• B. Polyuria
• C. Nocturia
• D. Hypertension

Correct answer: D

Rationale: In a client with diabetes insipidus, excessive thirst (polydipsia) and excessive urination (polyuria) are expected symptoms due to the inability to concentrate urine, leading to dilute urine production. Nocturia, waking up at night to urinate, is also common. However, hypertension is not a typical symptom of diabetes insipidus. The correct answer is D because hypertension may indicate a complication such as dehydration or electrolyte imbalances, which would require further assessment in a client with diabetes insipidus.

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