Nursing Elites

1. The client with type 2 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: Uncontrolled blood glucose levels are associated with an increased risk of cardiovascular complications, such as heart disease and stroke. High blood glucose levels can damage blood vessels over time, leading to atherosclerosis, which can increase the likelihood of heart disease and stroke. Improved wound healing (choice B) is not a consequence of uncontrolled blood glucose levels; in fact, high blood sugar levels can impair wound healing. Reduced need for medication (choice C) is inaccurate because uncontrolled blood glucose usually necessitates more medication to manage the condition. Decreased risk of infection (choice D) is also misleading as high blood glucose levels can compromise the immune system, making individuals more susceptible to infections.

2. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. What would the nurse expect the physician to do?

• A. Initiate insulin therapy.
• B. Switch the client to a different oral antidiabetic agent.
• C. Prescribe an additional oral antidiabetic agent.
• D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

Correct answer: A

Rationale: When a client experiences secondary failure to an oral antidiabetic agent like glipizide, the next step is often to initiate insulin therapy. This is because secondary failure indicates that the current oral antidiabetic medication is no longer effective in managing blood glucose levels, and insulin therapy may be required to adequately control blood sugar. Switching to a different oral antidiabetic agent may not be effective if there is already resistance to the current agent. Adding another oral antidiabetic agent may not address the underlying issue of secondary failure. Restricting carbohydrate intake is important for diabetes management but is not the primary intervention indicated in this scenario of secondary failure to glipizide.

3. When implementing a new policy on the unit, what process should a nurse manager follow?

• A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
• B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
• C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
• D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.

4. 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.

5. A client with type 1 DM is experiencing signs of hypoglycemia. The nurse should expect which of the following symptoms?

• A. Tachycardia
• B. Polyuria
• C. Flushed skin
• D. Dry mouth

Correct answer: A

Rationale: In a client experiencing hypoglycemia, tachycardia is a common symptom. This occurs due to the release of adrenaline in response to low blood glucose levels, which stimulates the heart to beat faster. Polyuria, the increased production of urine, flushed skin, and dry mouth are not typical symptoms of hypoglycemia. Polyuria is more commonly associated with conditions like diabetes insipidus or uncontrolled diabetes mellitus. Flushed skin and dry mouth are not direct physiological responses to low blood sugar levels.

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