Nursing Elites

1. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, Nurse Libby prepares to take emergency action to prevent the potential complication of:

• A. Thyroid storm.
• B. Cretinism.
• C. Myxedema coma.
• D. Hashimoto's thyroiditis.

Correct answer: C

Rationale: The scenario described with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area is indicative of myxedema coma, a severe and life-threatening complication of hypothyroidism. Myxedema coma requires immediate emergency treatment to prevent further deterioration. Choice A, thyroid storm, is a complication of hyperthyroidism characterized by an increase in body temperature, heart rate, and blood pressure. Choice B, cretinism, refers to untreated congenital hypothyroidism leading to mental and physical growth retardation. Choice D, Hashimoto's thyroiditis, is an autoimmune condition leading to hypothyroidism but does not present with the acute, life-threatening symptoms described in the scenario.

2. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

• A. Elevated blood glucose level and a low plasma bicarbonate
• B. Decreased urine output
• C. Increased respirations and an increase in pH
• D. Comatose state

Correct answer: A

Rationale: The correct answer is A: Elevated blood glucose level and a low plasma bicarbonate. Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketosis, and metabolic acidosis, reflected by a low plasma bicarbonate. Elevated blood glucose levels are a hallmark of DKA due to the body's inability to use glucose properly. Choices B, C, and D are incorrect. Decreased urine output is not a specific finding associated with DKA. Increased respirations and an increase in pH are not typical in DKA; in fact, respiratory compensation for the metabolic acidosis in DKA leads to Kussmaul breathing (deep, rapid breathing). A comatose state may occur in severe cases of DKA but is not a confirming finding for the diagnosis.

3. A client with diabetes mellitus is experiencing symptoms of hypoglycemia. The nurse should instruct the client to do which of the following?

• A. Eat a high-protein snack
• B. Consume 15 grams of simple carbohydrates
• C. Drink a glass of water
• D. Administer an extra dose of insulin

Correct answer: B

Rationale: Consuming 15 grams of simple carbohydrates is the recommended treatment for mild hypoglycemia to quickly raise blood sugar levels. Simple carbohydrates are rapidly absorbed and provide a quick source of glucose to combat low blood sugar. Eating a high-protein snack (Choice A) would delay the rise in blood sugar as proteins take longer to be broken down. Drinking water (Choice C) does not directly address the low blood sugar levels associated with hypoglycemia. Administering an extra dose of insulin (Choice D) would further lower blood sugar levels, worsening the hypoglycemic state.

4. A healthcare provider is educating a client with DM on recognizing symptoms of hypoglycemia. Which symptom should the healthcare provider mention?

• A. Increased thirst
• B. Frequent urination
• C. Sweating
• D. Weight loss

Correct answer: C

Rationale: The correct symptom to mention when educating a client with diabetes mellitus (DM) on hypoglycemia is sweating. Sweating is a common symptom of hypoglycemia as it occurs due to the activation of the sympathetic nervous system in response to low blood sugar levels. Increased thirst (Choice A) and frequent urination (Choice B) are more indicative of hyperglycemia (high blood sugar) rather than hypoglycemia. Weight loss (Choice D) is not a typical symptom associated with hypoglycemia.

5. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

• A. 2 to 5 g of a simple carbohydrate.
• B. 10 to 15 g of a simple carbohydrate.
• C. 18 to 20 g of a simple carbohydrate.
• D. 25 to 30 g of a simple carbohydrate.

Correct answer: B

Rationale: The correct answer is B: 10 to 15 g of a simple carbohydrate. In the treatment of hypoglycemia, it is important to administer a specific amount of simple carbohydrates to raise blood glucose levels effectively without causing hyperglycemia. 10 to 15 g of simple carbohydrates, such as glucose tablets, fruit juice, or regular soft drinks, is recommended to rapidly increase blood sugar levels in clients experiencing hypoglycemia. Choices A, C, and D are incorrect as they either provide too little or too much glucose, which may not effectively treat the hypoglycemic episode or may lead to rebound hyperglycemia.

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