Nursing Elites

1. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

• A. Antidiuretic hormone (ADH)
• B. Thyroid-stimulating hormone (TSH)
• C. Follicle-stimulating hormone (FSH)
• D. Luteinizing hormone (LH)

Correct answer: A

Rationale: Diabetes insipidus is a condition characterized by a deficiency of antidiuretic hormone (ADH). ADH plays a crucial role in regulating water balance by controlling the amount of water reabsorbed by the kidneys. Options B, C, and D are incorrect as they are not associated with diabetes insipidus. TSH (thyroid-stimulating hormone) is responsible for regulating thyroid function, while FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are involved in reproductive functions.

2. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

• A. Integumentary inspection for the presence of brown spots on the lower extremities.
• B. Observation for paleness of the lower extremities.
• C. Observation for blanching of the feet after the legs are elevated for 60 seconds.
• D. Palpation for increased pulse volume in the arteries of the lower extremities.

Correct answer: D

Rationale: In a patient with impaired peripheral arterial circulation, clinical nursing assessment should include integumentary inspection for the presence of brown spots, observation for paleness of the lower extremities, and observation for blanching of the feet after the legs are elevated for 60 seconds. Palpation for increased pulse volume in the arteries of the lower extremities is not consistent with impaired circulation, as pulses are typically diminished in this condition. Therefore, palpation for increased pulse volume is not relevant to the assessment of impaired peripheral arterial circulation.

3. The client with type 1 DM asks why it is necessary to rotate injection sites when managing insulin therapy. The nurse's best response is:

• A. It helps prevent skin irritation.
• B. It helps prevent scar tissue buildup.
• C. It ensures more consistent insulin absorption.
• D. It makes the injections less painful.

Correct answer: C

Rationale: Rotating injection sites is necessary to ensure more consistent insulin absorption. This practice helps maintain stable blood glucose levels by preventing the formation of lipohypertrophy (fatty lumps under the skin) at injection sites. Choices A and B are incorrect as the primary purpose of rotating injection sites is not focused on preventing skin irritation or scar tissue buildup. While rotating injection sites may contribute to reducing pain over time, the primary benefit is the consistency in insulin absorption to support glycemic control, making choice D less relevant.

4. A client with type 2 diabetes mellitus is being educated on foot care. Which of the following instructions should the nurse provide?

• A. Soak your feet in warm water daily.
• B. Avoid going barefoot to protect your feet.
• C. Inspect your feet daily for any cuts or sores.
• D. Avoid using a heating pad to warm your feet if they are cold.

Correct answer: C

Rationale: The correct instruction for a client with type 2 diabetes mellitus regarding foot care is to inspect their feet daily for any cuts or sores. This practice helps in early detection of potential issues like cuts, sores, or infections, which can be challenging to heal due to poor circulation in diabetes. Choice A is incorrect because soaking feet in hot water can lead to burns or skin damage, especially for individuals with diabetes who may have reduced sensation. Choice B is incorrect because going barefoot increases the risk of injuries and infections for individuals with diabetes. Choice D is incorrect because using a heating pad can also impair sensation, increasing the risk of burns or injuries for diabetic individuals.

5. A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?

• A. The best time for me to exercise is every afternoon.
• B. The best time for me to exercise is right after I eat.
• C. The best time for me to exercise is after breakfast.
• D. The best time for me to exercise is after my morning snack.

Correct answer: A

Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.

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