Nursing Elites

1. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. What would the nurse expect the physician to do?

• A. Initiate insulin therapy.
• B. Switch the client to a different oral antidiabetic agent.
• C. Prescribe an additional oral antidiabetic agent.
• D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

Correct answer: A

Rationale: When a client experiences secondary failure to an oral antidiabetic agent like glipizide, the next step is often to initiate insulin therapy. This is because secondary failure indicates that the current oral antidiabetic medication is no longer effective in managing blood glucose levels, and insulin therapy may be required to adequately control blood sugar. Switching to a different oral antidiabetic agent may not be effective if there is already resistance to the current agent. Adding another oral antidiabetic agent may not address the underlying issue of secondary failure. Restricting carbohydrate intake is important for diabetes management but is not the primary intervention indicated in this scenario of secondary failure to glipizide.

2. The client with type 2 DM is learning to manage blood glucose levels. When should the client monitor blood glucose?

• A. Only when feeling unwell.
• B. Only before meals.
• C. Before meals and at bedtime.
• D. Only after meals.

Correct answer: C

Rationale: The correct answer is to monitor blood glucose before meals and at bedtime. This timing allows the client to assess fasting levels and make informed decisions about mealtime insulin or medication doses. Monitoring only when feeling unwell (choice A) is not sufficient for proper glucose management as it may miss important trends. Monitoring only before meals (choice B) is helpful but does not provide a complete picture of the client's glucose control throughout the day. Monitoring only after meals (choice D) is less beneficial than monitoring before meals as it does not capture fasting levels. Therefore, monitoring before meals and at bedtime (choice C) is the most comprehensive approach to maintain good glucose control and prevent complications.

3. 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.

4. A client with type 1 DM is experiencing signs of hypoglycemia. The nurse should expect which of the following symptoms?

• A. Tachycardia
• B. Polyuria
• C. Flushed skin
• D. Dry mouth

Correct answer: A

Rationale: In a client experiencing hypoglycemia, tachycardia is a common symptom. This occurs due to the release of adrenaline in response to low blood glucose levels, which stimulates the heart to beat faster. Polyuria, the increased production of urine, flushed skin, and dry mouth are not typical symptoms of hypoglycemia. Polyuria is more commonly associated with conditions like diabetes insipidus or uncontrolled diabetes mellitus. Flushed skin and dry mouth are not direct physiological responses to low blood sugar levels.

5. Which of the following is a priority nursing diagnosis for a client with Addison's disease?

• A. Fluid volume deficit
• B. Risk for infection
• C. Imbalanced nutrition: Less than body requirements
• D. Disturbed body image

Correct answer: A

Rationale: The priority nursing diagnosis for a client with Addison's disease is 'Fluid volume deficit.' Addison's disease is characterized by adrenal insufficiency, resulting in decreased aldosterone production. Aldosterone plays a key role in sodium and water retention in the body. With its deficiency, there is an increased risk of dehydration and electrolyte imbalance, leading to fluid volume deficit. While infection risk, nutrition issues, and body image disturbances are also important considerations for holistic care, addressing the fluid volume deficit takes precedence due to the immediate physiological impact on the client's health and well-being.

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