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. The client with DM is being instructed by the nurse about the importance of controlling blood glucose levels. The nurse should emphasize that uncontrolled blood glucose can lead to:

• A. Increased risk of heart disease and stroke.
• B. Improved wound healing.
• C. Reduced need for medication.
• D. Decreased risk of infection.

Correct answer: A

Rationale: The correct answer is A: Increased risk of heart disease and stroke. Uncontrolled blood glucose levels in clients with diabetes mellitus (DM) can lead to cardiovascular complications, such as heart disease and stroke. High blood glucose levels can damage blood vessels over time, increasing the risk of atherosclerosis and cardiovascular events. Choices B, C, and D are incorrect because uncontrolled blood glucose levels do not improve wound healing, reduce the need for medication, or decrease the risk of infection. In fact, uncontrolled blood glucose levels can impair wound healing, require more medications to manage symptoms, and increase the risk of infections due to compromised immune function.

3. The client has undergone a thyroidectomy. Which of the following symptoms would indicate a potential complication?

• A. Bradycardia
• B. Tachycardia
• C. Hyperreflexia
• D. Hypocalcemia

Correct answer: D

Rationale: Hypocalcemia is a potential complication of thyroidectomy as it may occur if the parathyroid glands, responsible for calcium regulation, are inadvertently removed or damaged during the procedure. Bradycardia (slow heart rate) is not typically associated with thyroidectomy complications. Tachycardia (fast heart rate) is more commonly seen in hyperthyroidism. Hyperreflexia (exaggerated reflex responses) is not a typical complication of thyroidectomy.

4. A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be:

• A. High risk for deficient fluid volume
• B. Deficient knowledge: disease process and treatment
• C. Imbalanced nutrition: less than body requirements
• D. Disabled family coping: compromised

Correct answer: A

Rationale: The priority nursing diagnosis for a client with diabetes mellitus (DM) experiencing hyperglycemia would be 'High risk for deficient fluid volume.' Hyperglycemia can lead to osmotic diuresis, causing significant fluid loss and an increased risk of deficient fluid volume. This nursing diagnosis addresses the immediate physiological concern related to fluid balance.\n\nChoice B, 'Deficient knowledge: disease process and treatment,' focuses on the client's understanding of DM, which is important but not the priority when the client is at risk of fluid volume deficit.\n\nChoice C, 'Imbalanced nutrition: less than body requirements,' pertains to inadequate intake of nutrients, which is not the priority concern when fluid volume deficit poses a more immediate threat.\n\nChoice D, 'Disabled family coping: compromised,' addresses a psychosocial aspect and is not the priority over the critical physiological issue of fluid volume deficit in a client with hyperglycemia.

5. A female client with physical findings suggestive of a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, necessitating a transsphenoidal hypophysectomy. The evening before the surgery, Nurse Jacob reviews preoperative and postoperative instructions provided to the client earlier. Which postoperative instruction should the nurse emphasize?

• A. You must lie flat for 24 hours after surgery.
• B. You must avoid coughing, sneezing, and blowing your nose.
• C. You must restrict your fluid intake.
• D. You must report ringing in your ears immediately.

Correct answer: B

Rationale: Following a transsphenoidal hypophysectomy, it is crucial to avoid activities such as coughing, sneezing, and blowing the nose to prevent an increase in intracranial pressure or the risk of cerebrospinal fluid leakage. Coughing, sneezing, or nose blowing can strain the surgical site, potentially leading to complications. Lying flat for 24 hours is not typically required after this surgery. Fluid intake should be encouraged to prevent dehydration. Ringing in the ears is not a common complication associated with this type of surgery.

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