Nursing Elites

1. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

• A. Encourage the client to ask questions about personal sexuality.
• B. Provide time for privacy.
• C. Provide support for the spouse or significant other.
• D. Suggest referral to a sex counselor or other appropriate professional.

Correct answer: D

Rationale: The most appropriate intervention for a postoperative male client with diabetes mellitus who reports impotence and concerns about its impact on his marriage is to suggest referral to a sex counselor or other appropriate professional. Impotence can have significant emotional and relational effects, and a sex counselor is specifically trained to address such concerns. Encouraging the client to ask questions about personal sexuality (Choice A) may not provide the specialized support needed in this situation. Providing time for privacy (Choice B) is important but may not directly address the client's concerns about impotence. Providing support for the spouse or significant other (Choice C) is valuable but may not be as effective as seeking professional help to address the client's specific issue of impotence.

2. The client has hyperparathyroidism. Which of the following lab findings is consistent with this condition?

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

Correct answer: B

Rationale: Hyperparathyroidism leads to increased secretion of parathyroid hormone, which results in elevated calcium levels in the blood (hypercalcemia). Therefore, the correct lab finding consistent with hyperparathyroidism is hypercalcemia (Choice B). Hypocalcemia (Choice A) is not indicative of hyperparathyroidism as the condition is associated with high calcium levels. Hypokalemia (Choice C) is a low potassium level, which is not typically associated with hyperparathyroidism. Hyperphosphatemia (Choice D) refers to high phosphate levels and is not a characteristic finding in hyperparathyroidism.

3. The nurse is caring for a client with a history of adrenal insufficiency. The nurse should monitor for which of the following signs of an Addisonian crisis?

• A. Hypertension
• B. Hyperglycemia
• C. Severe hypotension
• D. Tachycardia

Correct answer: C

Rationale: In an Addisonian crisis, there is a lack of adrenal hormones leading to severe hypotension. Hypertension (choice A) is not a typical sign of Addisonian crisis but can occur in conditions like pheochromocytoma. Hyperglycemia (choice B) is not a characteristic sign of an Addisonian crisis. Tachycardia (choice D) may occur as a compensatory mechanism in response to hypotension, but severe bradycardia is more common in an Addisonian crisis.

4. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should Nurse Hans recognize as an adverse drug effect?

• A. Dysuria
• B. Leg cramps
• C. Tachycardia
• D. Blurred vision

Correct answer: C

Rationale: Tachycardia is a potential adverse effect of levothyroxine, indicating overmedication. Dysuria (painful urination) is not typically associated with levothyroxine. Leg cramps are not a common adverse effect of levothyroxine. Blurred vision is not a typical adverse effect of levothyroxine; instead, it may be a sign of other eye-related conditions or medication side effects.

5. A client with type 1 diabetes mellitus is experiencing hypoglycemia. What should the nurse instruct the client to do?

• A. Administer insulin immediately
• B. Consume 15 grams of simple carbohydrates
• C. Drink plenty of water
• D. Avoid eating until symptoms resolve

Correct answer: B

Rationale: When a client with type 1 diabetes mellitus experiences hypoglycemia, the nurse should instruct them to consume 15 grams of simple carbohydrates. This is the recommended initial treatment for hypoglycemia as it helps quickly raise blood sugar levels to alleviate symptoms and prevent complications. Administering insulin immediately (Choice A) would further lower blood sugar levels, worsening the hypoglycemia. Drinking plenty of water (Choice C) and avoiding eating until symptoms resolve (Choice D) are not appropriate actions for treating hypoglycemia as they do not address the immediate need to raise blood sugar levels.

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