Nursing Elites

1. A client with newly diagnosed diabetes mellitus is receiving teaching on foot care. Which instruction should the nurse include?

• A. Walk barefoot whenever possible to toughen your feet.
• B. Soak your feet in hot water daily to improve circulation.
• C. Trim your toenails straight across to prevent ingrown toenails.
• D. Use a heating pad to keep your feet warm.

Correct answer: C

Rationale: Correctly trimming toenails straight across is crucial in preventing ingrown toenails and potential infections in individuals with diabetes. Ingrown toenails can lead to complications, so it is essential for diabetic clients to practice proper nail care to avoid these issues. Choices A, B, and D are incorrect. Walking barefoot can increase the risk of foot injuries, soaking feet in hot water can cause burns or skin damage, and using a heating pad can lead to burns or injuries due to decreased sensation in the feet, which is common in diabetes.

2. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

• A. Monitoring for signs of hyperkalemia
• B. Checking for signs of hypoglycemia
• C. Assessing for signs of dehydration
• D. Observing for symptoms of hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

3. The nurse is planning care for a 16-year-old with juvenile rheumatoid arthritis (JRA). The nurse includes activities to strengthen and mobilize the joints and surrounding muscles. Which physical therapy regimen should the nurse encourage the adolescent to implement?

• A. Exercise in a swimming pool.
• B. Splint affected joints during activity.
• C. Perform passive range of motion exercises twice daily.
• D. Begin a training program of lifting weights and running.

Correct answer: A

Rationale: Exercising in a swimming pool is beneficial for adolescents with juvenile rheumatoid arthritis as it reduces stress on the joints while allowing movement and strengthening. The buoyancy of water supports the body, making exercises easier and less painful, while also providing resistance to strengthen muscles. This form of exercise can help improve joint mobility and overall function without causing excessive strain on the joints. Choices B, C, and D are incorrect because splinting affected joints, performing passive range of motion exercises, or beginning a training program of lifting weights and running can potentially exacerbate symptoms and cause additional stress on the joints, which is not recommended for individuals with juvenile rheumatoid arthritis.

4. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be

• A. Antibiotic therapy with ciprofloxacin and metronidazole
• B. Referral for urgent colonoscopy
• C. Referral to a surgeon for immediate hemicolectomy
• D. Barium enema

Correct answer: A

Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

5. What health promotion teaching should prioritize to prevent drug-induced hepatitis?

• A. Finish all prescribed courses of antibiotics, regardless of symptom resolution
• B. Adhere to dosing recommendations of over-the-counter analgesics
• C. Ensure that expired medications are disposed of safely
• D. Ensure that pharmacists regularly review drug regimens for potential interactions

Correct answer: B

Rationale: Adhering to dosing recommendations of over-the-counter analgesics is crucial in preventing drug-induced hepatitis. Overdosing on analgesics can lead to liver damage, making it essential to follow the recommended dosages to reduce the risk of hepatotoxicity.

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