Nursing Elites

1. A nurse is preparing to administer NPH insulin to a client with DM. The nurse notes that the NPH insulin vial is cloudy. The nurse should:

• A. Obtain a new vial of NPH insulin.
• B. Draw up the cloudy insulin as ordered.
• C. Shake the vial vigorously before drawing up the insulin.
• D. Warm the insulin to room temperature before administration.

Correct answer: B

Rationale: The correct answer is to draw up the cloudy insulin as ordered. NPH insulin is inherently cloudy due to its suspension of insulin crystals. Shaking the vial vigorously can lead to denaturation of the insulin molecules, altering its efficacy. Warming NPH insulin is not necessary as it can cause breakdown of insulin molecules. The nurse should gently roll the vial between hands to mix it before drawing it up to ensure an even distribution of insulin in the suspension.

2. Which of the following actions could be considered a breach of patient confidentiality?

• A. Discussing patient information with other healthcare providers in a private setting.
• B. Sharing patient information with family members without the patient's consent.
• C. Discussing patient information in public areas where others may overhear.
• D. Sharing patient information in a private, secure setting with other healthcare providers involved in the patient's care.

Correct answer: C

Rationale: Discussing patient information in public areas where others may overhear is considered a breach of patient confidentiality because it compromises the privacy and confidentiality of the patient's health information. Choices A and D are not breaches of confidentiality as discussing patient information with other healthcare providers in a private setting or in a private, secure setting with those involved in the patient's care is appropriate. Choice B is also incorrect as sharing patient information with family members without the patient's consent could potentially be a breach of privacy but is not the best answer in this context.

3. Which of the following clinical findings would be most concerning in a client with hypothyroidism?

• A. Bradycardia
• B. Dry skin
• C. Constipation
• D. Depression

Correct answer: A

Rationale: Bradycardia in a client with hypothyroidism is the most concerning finding as it may indicate severe hypothyroidism, leading to decreased heart rate. Bradycardia can be a sign of myxedema coma, a life-threatening condition that requires immediate medical attention. Dry skin, constipation, and depression are common symptoms associated with hypothyroidism but are not as acutely concerning as bradycardia.

4. A client at risk for hypokalemia is being instructed by a nurse about foods high in potassium that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that the food item lowest in potassium is:

• A. Apples
• B. Carrots
• C. Spinach
• D. Avocado

Correct answer: A

Rationale: The correct answer is 'Apples.' Apples are the lowest in potassium among the given options. Carrots, spinach, and avocados are all higher in potassium content compared to apples. Carrots and spinach are vegetables known to have a moderate amount of potassium. Avocados, on the other hand, are a high-potassium fruit and would not be the lowest in potassium among the choices provided.

5. The client with DM is being taught by the nurse about the importance of monitoring blood glucose levels. The nurse should instruct the client to:

• A. Check blood glucose only when feeling unwell.
• B. Check blood glucose before meals and at bedtime.
• C. Check blood glucose only after meals.
• D. Check blood glucose only in the morning.

Correct answer: B

Rationale: The correct answer is to check blood glucose before meals and at bedtime. Monitoring blood glucose levels before meals allows the client to adjust their insulin or oral antidiabetic medications based on their current levels. Checking at bedtime helps in ensuring blood glucose levels are at a safe range throughout the night. Option A is incorrect because blood glucose should be monitored regularly as part of diabetes management, not just when feeling unwell. Option C is incorrect because checking only after meals does not provide a complete picture of blood glucose control throughout the day. Option D is incorrect as checking only in the morning does not cover the full spectrum of blood glucose variations that can occur during the day.

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