Nursing Elites

1. A client is admitted to the ER with DKA. In the acute phase, the priority nursing action is to prepare to:

• A. Administer regular insulin intravenously
• B. Administer 5% dextrose intravenously
• C. Correct the acidosis
• D. Apply an electrocardiogram monitor

Correct answer: A

Rationale: Administering regular insulin intravenously is the priority nursing action in the acute phase of DKA. Insulin helps to lower blood glucose levels by promoting cellular uptake of glucose and inhibiting ketone production. Administering dextrose would be counterproductive as it can worsen hyperglycemia. Correcting acidosis is important but usually follows insulin administration. Applying an electrocardiogram monitor is not the priority action in the acute management of DKA.

2. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

• A. Be sure to take glipizide 30 minutes before meals.
• B. Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.
• C. You won't need to check your blood glucose level after you start taking glipizide.
• D. Take glipizide after a meal to prevent heartburn.

Correct answer: A

Rationale: Glipizide should be taken 30 minutes before meals to maximize its glucose-lowering effect.

3. A client with Addison's disease is being educated about managing the condition during times of stress. The nurse should instruct the client to:

• A. Double the dose of corticosteroids during periods of stress.
• B. Skip the dose of corticosteroids if you feel well.
• C. Decrease fluid intake to prevent hypertension.
• D. Avoid physical activity during stressful times.

Correct answer: A

Rationale: Clients with Addison's disease should be educated to double their corticosteroid dosage during periods of stress. This is crucial to prevent adrenal crisis, as stress can increase the body's demand for cortisol. Skipping doses when feeling well can lead to an adrenal crisis if stress occurs suddenly. Decreasing fluid intake can exacerbate dehydration and electrolyte imbalances, which are already concerns in Addison's disease. Avoiding physical activity during stressful times is not the most appropriate advice; moderate physical activity can be beneficial, as long as the client is adequately managing their corticosteroid regimen.

4. The healthcare provider is monitoring a client with Cushing's syndrome. Which of the following findings should the healthcare provider report?

• A. Hypotension
• B. Hyperglycemia
• C. Weight loss
• D. Hypokalemia

Correct answer: B

Rationale: In Cushing's syndrome, hyperglycemia is a common finding due to increased cortisol levels leading to insulin resistance. This can have serious implications such as diabetes mellitus and should be promptly reported for appropriate management. Hypotension (choice A) is more commonly associated with Addison's disease, not Cushing's syndrome. Weight gain rather than weight loss (choice C) is typically observed in clients with Cushing's syndrome. While hypokalemia (choice D) can occur in Cushing's syndrome due to excess cortisol affecting potassium levels, it is not as critical as hyperglycemia and may not be the priority for immediate reporting.

5. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical findings should the nurse expect?

• A. Hyponatremia
• B. Hyperkalemia
• C. Hypercalcemia
• D. Hypernatremia

Correct answer: A

Rationale: In SIADH, there is excessive release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. Hyponatremia is a hallmark finding in SIADH due to the imbalance between water and sodium levels. Hyperkalemia (Choice B) is not typically associated with SIADH. Hypercalcemia (Choice C) involves elevated calcium levels, which are not directly related to SIADH. Hypernatremia (Choice D) is the opposite of what occurs in SIADH, where sodium levels are usually diluted due to water retention.

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