Nursing Elites

1. The healthcare professional is educating a client with Cushing's syndrome about dietary management. Which of the following instructions should the healthcare professional include?

• A. Increase sodium intake
• B. Limit protein intake
• C. Limit calcium intake
• D. Increase potassium intake

Correct answer: D

Rationale: For clients with Cushing's syndrome, they are at risk of developing hypokalemia due to increased excretion of potassium. Therefore, it is essential to advise them to increase their potassium intake. Choices A, B, and C are incorrect because: A) Increasing sodium intake can worsen fluid retention and hypertension common in Cushing's syndrome. B) Limiting protein intake is not necessary unless there are specific kidney issues that require protein restriction. C) Limiting calcium intake is not typically recommended unless there are underlying conditions such as hypercalcemia.

2. Which of the following laboratory values should the nurse monitor in a client with Cushing's syndrome?

• A. Blood glucose levels
• B. Serum calcium levels
• C. Serum potassium levels
• D. Serum sodium levels

Correct answer: A

Rationale: The correct answer is A: Blood glucose levels. In Cushing's syndrome, there is excess cortisol in the body which leads to increased blood glucose levels due to its effect on glucose metabolism. Elevated blood glucose levels are a common finding in individuals with Cushing's syndrome. Monitoring blood glucose levels is crucial as it helps in assessing and managing hyperglycemia in these patients. Choice B, serum calcium levels, is not typically a priority in monitoring for Cushing's syndrome. While abnormalities in calcium levels can occur in some endocrine disorders, hypercalcemia is not a hallmark of Cushing's syndrome. Choice C, serum potassium levels, and Choice D, serum sodium levels, are not directly associated with Cushing's syndrome. While electrolyte imbalances can occur in various conditions, they are not specifically linked to Cushing's syndrome as blood glucose levels are.

3. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?

• A. Acromegaly
• B. Type 1 diabetes mellitus
• C. Hypothyroidism
• D. Deficient growth hormone

Correct answer: A

Rationale: The correct answer is Acromegaly. Jemma's symptoms of large hands, hoarse voice, and snoring are indicative of acromegaly, a disorder caused by excessive growth hormone production. Acromegaly can lead to insulin resistance, which can result in hyperglycemia. Choice B, Type 1 diabetes mellitus, is unlikely in this case as the symptoms and presentation are more suggestive of acromegaly. Choice C, Hypothyroidism, typically presents with different symptoms such as weight gain, fatigue, and cold intolerance, not consistent with Jemma's symptoms. Choice D, Deficient growth hormone, would not lead to the signs and symptoms observed in Jemma, as her condition is characterized by excessive growth hormone production.

4. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with his ability to go outdoors. Based on these assessment findings, Nurse Richard would suspect which of the following disorders?

• A. Diabetes mellitus
• B. Diabetes insipidus
• C. Hypoparathyroidism
• D. Hyperparathyroidism

Correct answer: D

Rationale: The symptoms described in the scenario, such as bone pain, increased urination, anorexia, and weakness, are indicative of hyperparathyroidism. In hyperparathyroidism, there is an excess of parathyroid hormone leading to increased calcium levels, which can result in bone pain and various systemic effects. Choices A, B, and C are incorrect because they do not align with the symptoms presented by the client. Diabetes mellitus primarily presents with polyuria, polydipsia, and hyperglycemia. Diabetes insipidus manifests as polyuria and polydipsia with dilute urine. Hypoparathyroidism usually presents with hypocalcemia, causing symptoms like muscle cramps, tingling sensations, and seizures.

5. A client with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which of the following interventions should the nurse implement first?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct first intervention in the treatment of a client with diabetic ketoacidosis (DKA) is to start an intravenous line and infuse normal saline. This is essential for fluid resuscitation to restore intravascular volume and improve perfusion. Administering intravenous insulin can lead to further potassium depletion without first addressing dehydration and electrolyte imbalances. Monitoring serum potassium levels is important but should follow fluid resuscitation to avoid life-threatening hypokalemia. Obtaining an arterial blood gas (ABG) is necessary to assess the acid-base status but is not the initial priority when managing DKA.

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