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 type 2 diabetes mellitus is prescribed metformin. The nurse should monitor the client for which of the following potential side effects?

• A. Lactic acidosis
• B. Hypokalemia
• C. Hyperglycemia
• D. Weight gain

Correct answer: A

Rationale: The correct answer is A, lactic acidosis. Metformin, a common medication for type 2 diabetes mellitus, can lead to lactic acidosis, particularly in individuals with renal impairment or predisposing factors. Monitoring for signs of lactic acidosis, such as muscle pain, weakness, trouble breathing, dizziness, and slow or uneven heart rate, is crucial to prevent serious complications. Choices B, C, and D are incorrect as metformin does not typically cause hypokalemia, hyperglycemia, or weight gain as its primary side effects.

3. A client with DM is preparing for a foot care exam. The nurse should advise the client to:

• A. Wear loose-fitting shoes to protect the feet.
• B. Apply lotion to the tops and bottoms of the feet to keep the skin moist.
• C. Avoid using a heating pad to prevent burns on the feet.
• D. Avoid using sharp instruments to trim the toenails.

Correct answer: D

Rationale: The correct answer is to advise the client to avoid using sharp instruments to trim the toenails. This is crucial because using sharp instruments can lead to injuries such as cuts or wounds, increasing the risk of infections, especially in clients with diabetes who have decreased sensation in their feet. Choice A is incorrect because tight shoes can restrict circulation and increase the risk of pressure sores. Choice B is incorrect because applying lotion between the toes can create a moist environment, leading to fungal infections. Choice C is incorrect because using a heating pad can lead to burns, which can go unnoticed due to decreased sensation in diabetic feet.

4. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following interventions should the nurse implement?

• A. Encourage increased fluid intake
• B. Administer vasopressin
• C. Monitor for signs of dehydration
• D. Restrict oral fluids

Correct answer: D

Rationale: The correct intervention for a client with syndrome of inappropriate antidiuretic hormone (SIADH) is to restrict oral fluids. SIADH leads to excessive release of antidiuretic hormone (ADH), causing the body to retain water and diluting the sodium levels in the blood (hyponatremia). Restricting oral fluids helps prevent further water retention and worsening hyponatremia. Encouraging increased fluid intake (choice A) would exacerbate the problem by further diluting sodium levels. Administering vasopressin (choice B) is not indicated in SIADH, as the condition is characterized by excess ADH secretion. Monitoring for signs of dehydration (choice C) is not the priority in SIADH since the issue is water retention rather than dehydration.

5. The client with newly diagnosed type 2 diabetes mellitus is being taught about self-care management. Which of the following statements indicates a need for further teaching?

• A. I will rotate my injection sites to prevent skin damage.
• B. I can stop taking my medication if my blood sugar is normal.
• C. I should monitor my blood sugar levels regularly.
• D. I should follow a healthy diet and exercise regularly.

Correct answer: B

Rationale: The correct answer is B. Clients with type 2 diabetes mellitus should not stop taking their medication even if blood sugar levels are normal. This is because ongoing management is necessary to control blood sugar levels and prevent complications. Choice A is correct as rotating injection sites helps prevent skin damage and improves insulin absorption. Choice C is correct as regular monitoring of blood sugar levels is vital for managing diabetes effectively. Choice D is correct as following a healthy diet and exercising regularly are key components of diabetes management.

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