Nursing Elites

1. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?

• A. Be sure to take glipizide 30 minutes before meals.
• B. Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.
• C. You won't need to check your blood glucose level after you start taking glipizide.
• D. Take glipizide after a meal to prevent heartburn.

Correct answer: A

Rationale: Glipizide should be taken 30 minutes before meals to maximize its glucose-lowering effect.

2. A client with Addison's disease is being educated on managing the condition. Which of the following statements indicates a need for further teaching?

• A. I should carry an emergency kit with hydrocortisone at all times.
• B. I need to increase my sodium intake during hot weather.
• C. I can skip my medication if I feel well.
• D. I should avoid stress as much as possible.

Correct answer: C

Rationale: The correct answer is C. Clients with Addison's disease should not skip their medication, even if they feel well, as consistent medication is necessary to manage the condition. Choice A is correct as carrying an emergency kit with hydrocortisone is essential for managing potential adrenal crises. Choice B is correct as increasing sodium intake during hot weather helps prevent electrolyte imbalances. Choice D is correct as stress can trigger adrenal crisis in individuals with Addison's disease, so stress management is crucial.

3. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical manifestations should the nurse expect?

• A. Hypernatremia
• B. Hypotension
• C. Decreased urine output
• D. Polyuria

Correct answer: C

Rationale: The correct answer is C: 'Decreased urine output.' Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone, leading to water retention and decreased urine output. Therefore, the nurse should expect the client to have decreased urine output. Choices A, B, and D are incorrect. Hypernatremia (Choice A) is not typically associated with SIADH as it usually leads to dilutional hyponatremia. Hypotension (Choice B) is not a common clinical manifestation of SIADH. Polyuria (Choice D) is the opposite of what is expected in a client with SIADH, who typically presents with decreased urine output.

4. When should a new nurse graduate consider applying for a position as a nurse manager?

• A. When she is comfortable in her current position
• B. When she begins mentoring other new nurses
• C. As soon as a position opens
• D. When she has developed leadership and clinical expertise

Correct answer: D

Rationale: A new nurse graduate should consider applying for a nurse manager position when they have developed both leadership and clinical expertise. This ensures that they are well-prepared for the responsibilities of the role. Choice A is incorrect because being comfortable in the current position does not necessarily equate to having the required skills for a nurse manager role. Choice B is incorrect as mentoring other new nurses, while valuable, may not directly align with the skills needed for a managerial position. Choice C is incorrect as applying for a nurse manager position solely because a position is available does not guarantee readiness for the role.

5. What is the lowest fasting plasma glucose level suggestive of a diagnosis of DM?

• A. 90 mg/dl.
• B. 115 mg/dl.
• C. 126 mg/dl.
• D. 180 mg/dl.

Correct answer: C

Rationale: A fasting plasma glucose level of 126 mg/dl or higher is diagnostic of diabetes mellitus. Choice A (90 mg/dl) is too low to indicate diabetes. Choice B (115 mg/dl) is also below the diagnostic threshold for diabetes. Choice D (180 mg/dl) is above the diagnostic threshold and would indicate uncontrolled diabetes, not the lowest level suggestive of a diagnosis.

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