Nursing Elites

1. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:

• A. Elevated serum bicarbonate and decreased blood pH.
• B. Signs of hypoglycemia earlier than expected.
• C. Symptoms of hyperglycemia due to NPH insulin peak time.
• D. Presence of sugar in the urine.

Correct answer: B

Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.

2. A client with Addison's disease is at risk for which of the following complications?

• A. Hypertension
• B. Hypovolemia
• C. Hypernatremia
• D. Hypokalemia

Correct answer: B

Rationale: A client with Addison's disease is at risk for hypovolemia. Addison's disease is characterized by adrenal insufficiency, particularly cortisol and aldosterone deficiency. Aldosterone deficiency leads to impaired sodium and water retention, resulting in decreased blood volume and hypovolemia. This condition can cause hypotension, not hypertension (Choice A), as reduced blood volume leads to decreased pressure. Hypernatremia (Choice C) is unlikely in Addison's disease because of the loss of sodium along with water in hypovolemia. Hypokalemia (Choice D) can occur due to aldosterone deficiency, but it is not the primary complication associated with Addison's disease.

3. The healthcare provider is providing dietary instructions to a client with hyperthyroidism. Which of the following foods should the client avoid?

• A. Seafood
• B. Spinach
• C. Bananas
• D. Oatmeal

Correct answer: A

Rationale: The client with hyperthyroidism should avoid foods high in iodine, as it can exacerbate the condition by increasing thyroid hormone production. Seafood, particularly ocean fish, is rich in iodine, making it a food to avoid. Spinach, bananas, and oatmeal do not contain high levels of iodine and are generally safe for individuals with hyperthyroidism.

4. A healthcare professional is reading a physician's progress notes in the client's record and reads that the physician has documented 'insensible fluid loss of approximately 800 mL daily.' The healthcare professional understands that this type of fluid loss can occur through:

• A. The skin
• B. Urinary output
• C. Wound drainage
• D. The gastrointestinal tract

Correct answer: A

Rationale: Insensible fluid loss refers to the fluid lost from the body that is not easily measured, such as through sweating and respiration. The skin is a major contributor to insensible fluid loss due to evaporation of water through the skin. Choice B, urinary output, represents measurable fluid loss through urine excretion. Choice C, wound drainage, is a measurable form of fluid loss that occurs externally from a wound. Choice D, the gastrointestinal tract, primarily involves fluid loss through feces and is also a measurable form of output. Therefore, the correct answer is 'A: The skin,' as it is the main route for insensible fluid loss.

5. What health concerns should Nurse Oliver expect a client with hypothyroidism to report?

• A. Increased appetite and weight loss
• B. Puffiness of the face and hands
• C. Nervousness and tremors
• D. Thyroid gland swelling

Correct answer: B

Rationale: Puffiness of the face and hands is a classic symptom of hypothyroidism. This occurs due to fluid retention and is commonly observed in individuals with an underactive thyroid gland. Increased appetite and weight loss (Choice A) are more indicative of hyperthyroidism, where there is an overproduction of thyroid hormones leading to increased metabolism. Nervousness and tremors (Choice C) are associated with hyperthyroidism, not hypothyroidism. Thyroid gland swelling (Choice D) typically indicates goiter, which can be present in both hyperthyroidism and hypothyroidism but is not a specific symptom that clients with hypothyroidism commonly report.

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