Nursing Elites

1. The nurse is caring for a client with Addison's disease. The client exhibits signs of hypotension, dehydration, and confusion. The nurse should anticipate administering which of the following medications?

• A. Insulin
• B. Hydrocortisone
• C. Levothyroxine
• D. Methimazole

Correct answer: B

Rationale: In Addison's disease, the adrenal glands do not produce enough cortisol. Hydrocortisone is a glucocorticoid medication that is used to replace deficient cortisol levels in patients with Addison's disease. It helps stabilize blood pressure and fluid balance. Insulin (Choice A) is used to manage diabetes, not Addison's disease. Levothyroxine (Choice C) is a thyroid hormone replacement used to treat hypothyroidism, not Addison's disease. Methimazole (Choice D) is used in the treatment of hyperthyroidism, not Addison's disease.

2. A nurse is assigned to care for a group of clients. On reviewing the clients' medical records, the nurse determines that which client is at risk for deficient fluid volume?

• A. A client with a colostomy
• B. A client with congestive heart failure
• C. A client with decreased kidney function
• D. A client receiving frequent wound irrigations

Correct answer: A

Rationale: The correct answer is A. Clients with a colostomy are at risk for deficient fluid volume due to the loss of fluid through the colostomy. In colostomy, there can be increased fluid loss through the stoma, which may lead to dehydration and electrolyte imbalances. Choices B, C, and D do not directly relate to the risk for deficient fluid volume. Clients with congestive heart failure are more prone to fluid overload rather than deficient volume. Clients with decreased kidney function are at risk for fluid retention, not deficient volume. Clients receiving frequent wound irrigations may be at risk for infection, but this does not directly indicate deficient fluid volume.

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. The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which action should the nurse implement first?

• A. Start a new IV in the right hand.
• B. Discontinue the intravenous line.
• C. Complete an incident record.
• D. Place a warm washcloth over the site.

Correct answer: B

Rationale: The first action should be to discontinue the intravenous line to prevent further complications such as infection or thrombophlebitis. Starting a new IV in the right hand is not the priority as addressing the current issue is important. Completing an incident record can be done after addressing the immediate concern of the IV site. Placing a warm washcloth over the site does not address the red streak and tenderness, which may indicate an infection that requires discontinuation of the IV line.

5. The client with DM is being taught by the nurse about the importance of monitoring blood glucose levels. The nurse should instruct the client to:

• A. Check blood glucose only when feeling unwell.
• B. Check blood glucose before meals and at bedtime.
• C. Check blood glucose only after meals.
• D. Check blood glucose only in the morning.

Correct answer: B

Rationale: The correct answer is to check blood glucose before meals and at bedtime. Monitoring blood glucose levels before meals allows the client to adjust their insulin or oral antidiabetic medications based on their current levels. Checking at bedtime helps in ensuring blood glucose levels are at a safe range throughout the night. Option A is incorrect because blood glucose should be monitored regularly as part of diabetes management, not just when feeling unwell. Option C is incorrect because checking only after meals does not provide a complete picture of blood glucose control throughout the day. Option D is incorrect as checking only in the morning does not cover the full spectrum of blood glucose variations that can occur during the day.

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