Nursing Elites

1. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?

• A. Hypocalcemia
• B. Hypercalcemia
• C. Hypokalemia
• D. Hyperkalemia

Correct answer: A

Rationale: Chvostek's and Trousseau's signs are clinical manifestations that suggest hypocalcemia, a common complication following thyroidectomy. Chvostek's sign is elicited by tapping the facial nerve, resulting in facial muscle contraction, while Trousseau's sign is provoked by inflating a blood pressure cuff, leading to carpal spasm. Both signs are indicative of low calcium levels in the blood. Therefore, options B, C, and D are incorrect as they do not correlate with the signs specifically associated with hypocalcemia.

2. A client with Cushing's syndrome is being assessed by the nurse. Which of the following clinical manifestations is consistent with this condition?

• A. Moon face
• B. Weight loss
• C. Hyperpigmentation
• D. Hypotension

Correct answer: A

Rationale: The correct clinical manifestation consistent with Cushing's syndrome is a 'moon face.' Cushing's syndrome is characterized by fat redistribution, leading to the round and full appearance of the face known as a moon face. Choice B, weight loss, is not common in Cushing's syndrome as patients often experience weight gain. Choice C, hyperpigmentation, is more indicative of Addison's disease, not Cushing's syndrome. Choice D, hypotension, is not typically associated with Cushing's syndrome which often presents with hypertension due to excess cortisol.

3. The client with hypothyroidism is being educated by the healthcare provider about taking levothyroxine. Which of the following instructions should be included?

• A. Take the medication with meals
• B. Take the medication at bedtime
• C. Take the medication on an empty stomach in the morning
• D. Take the medication with a glass of milk

Correct answer: C

Rationale: The correct answer is to take levothyroxine on an empty stomach in the morning. This instruction is essential to enhance absorption and efficacy of the medication. Taking levothyroxine with meals, at bedtime, or with a glass of milk can interfere with its absorption and effectiveness, leading to suboptimal treatment outcomes.

4. 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.

5. An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

• A. Gives small continuous doses of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.
• B. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.
• C. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.
• D. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Correct answer: A

Rationale: The correct answer is A. An external insulin pump delivers small continuous doses of regular insulin subcutaneously throughout the day to meet the basal insulin needs. The client can also self-administer a bolus dose with an additional dosage from the pump before each meal to cover the mealtime insulin needs. Option B is incorrect as insulin pumps do not typically release programmed doses of insulin into the bloodstream at specific intervals; instead, they infuse insulin subcutaneously. Option C is incorrect as insulin pumps are not surgically attached to the pancreas; they are worn externally. Option D is incorrect as NPH insulin is not commonly used in insulin pumps, and the pumps do not continuously infuse insulin directly into the bloodstream but rather subcutaneously.

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