Nursing Elites

1. The client has syndrome of inappropriate antidiuretic hormone (SIADH). Which intervention is most appropriate?

• A. Encourage increased fluid intake
• B. Administer hypertonic saline
• C. Monitor for signs of dehydration
• D. Restrict oral fluids

Correct answer: D

Rationale: The correct intervention for a client with syndrome of inappropriate antidiuretic hormone (SIADH) is to restrict oral fluids. This is because SIADH leads to excessive production of antidiuretic hormone, causing water retention and dilutional hyponatremia. By restricting oral fluids, the nurse helps prevent further water retention and imbalance of electrolytes. Encouraging increased fluid intake (Choice A) would exacerbate the condition by further increasing fluid retention. Administering hypertonic saline (Choice B) is not the primary treatment for SIADH, as it may worsen the imbalance. Monitoring for signs of dehydration (Choice C) is not appropriate since SIADH leads to water retention, not dehydration.

2. A client with diabetes insipidus is being treated with desmopressin. The nurse should monitor for which of the following side effects?

• A. Hyponatremia
• B. Hypernatremia
• C. Hypokalemia
• D. Hypercalcemia

Correct answer: A

Rationale: The correct answer is A: Hyponatremia. Desmopressin, a medication used in diabetes insipidus, can cause water retention by increasing water reabsorption in the kidneys. This excess water retention can lead to dilutional hyponatremia, where sodium levels in the body become too low. Monitoring for hyponatremia is crucial to prevent complications such as neurological symptoms. Choices B, C, and D are incorrect because desmopressin is not known to cause hypernatremia, hypokalemia, or hypercalcemia.

3. A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client's anxiety would be to:

• A. Administer a sedative
• B. Make sure the client knows all the correct medical terms to understand what is happening.
• C. Ignore the signs and symptoms of anxiety so that they will soon disappear.
• D. Convey empathy, trust, and respect toward the client.

Correct answer: D

Rationale: Conveying empathy, trust, and respect can help reduce the client's anxiety and improve their overall experience during treatment. This approach creates a supportive environment and fosters a sense of safety and understanding for the client. Administering a sedative (Choice A) should not be the initial intervention for anxiety, as it does not address the underlying emotional needs of the client. Making sure the client knows all the correct medical terms (Choice B) may increase anxiety by overwhelming the client with technical information. Ignoring signs and symptoms of anxiety (Choice C) can lead to worsening distress and potential complications in the client's care.

4. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

• A. Hypotension.
• B. Thick, coarse skin.
• C. Deposits of adipose tissue in the trunk and dorsocervical area.
• D. Weight gain in arms and legs.

Correct answer: C

Rationale: In Cushing's syndrome, the characteristic features include central obesity with deposits of adipose tissue in the trunk and dorsocervical area, often referred to as a 'buffalo hump.' Hypotension (Choice A) is not typically associated with Cushing's syndrome; instead, hypertension is more common. Thick, coarse skin (Choice B) is seen in conditions like hypothyroidism, not specifically in Cushing's syndrome. Weight gain in the arms and legs (Choice D) is not a typical finding in Cushing's syndrome; rather, weight gain is more prominent in the central areas of the body.

5. 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.

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