Nursing Elites

1. The client with newly diagnosed diabetes mellitus is receiving education from the nurse on managing blood glucose levels. Which statement indicates a need for further teaching?

• A. I will monitor my blood glucose levels regularly.
• B. I can eat whatever I want as long as I take my medication.
• C. I should exercise regularly to help control my blood sugar.
• D. I will rotate my injection sites to avoid tissue damage.

Correct answer: B

Rationale: Choice B indicates a need for further teaching because it suggests that the client can eat whatever they want as long as they take their medication, which is incorrect. Clients with diabetes mellitus need to follow a healthy and balanced diet in addition to taking their medication to effectively manage blood glucose levels. Choices A, C, and D are correct statements for managing diabetes. Monitoring blood glucose levels regularly, engaging in regular exercise to help control blood sugar, and rotating injection sites to avoid tissue damage are all important aspects of diabetes management.

2. Nurse Troy is aware that the most appropriate nursing diagnosis for a client with Addison's disease is:

• A. Risk for infection
• B. Excessive fluid volume
• C. Urinary retention
• D. Hypothermia

Correct answer: A

Rationale: The most appropriate nursing diagnosis for a client with Addison's disease is 'Risk for infection.' Addison's disease is characterized by corticosteroid deficiency, which leads to immune suppression, making these clients more susceptible to infections. This diagnosis reflects the increased vulnerability of clients with Addison's disease to infections. Choices B, C, and D are incorrect because Addison's disease does not typically present with excessive fluid volume, urinary retention, or hypothermia as primary concerns.

3. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

• A. They contain exudate and provide a moist wound environment.
• B. They protect the wound from mechanical trauma and promote healing.
• C. They debride the wound and promote healing by secondary intention.
• D. They prevent the entrance of microorganisms and minimize wound discomfort.

Correct answer: C

Rationale: Wet-to-dry dressings are utilized in this case to debride the wound by removing dead tissue and promoting healing by secondary intention. Choice A is incorrect as wet-to-dry dressings do not provide a moist wound environment; instead, they promote drying to aid in debridement. Choice B is incorrect because their primary purpose is not to protect the wound but to remove dead tissue. Choice D is incorrect as the main function of wet-to-dry dressings is not to prevent the entrance of microorganisms or minimize wound discomfort.

4. A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, Nurse Tyzz notes that the client is agitated, irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

• A. Depression
• B. Neuropathy
• C. Hypoglycemia
• D. Hyperthyroidism

Correct answer: A

Rationale: The correct answer is A: Depression. Depression is a common psychological manifestation in clients with Cushing's syndrome. In this scenario, the client's symptoms of agitation, irritability, poor memory, loss of appetite, and disheveled appearance are indicative of depressive symptoms rather than neuropathy, hypoglycemia, or hyperthyroidism. Neuropathy typically presents with sensory changes and motor deficits, which are not described in the scenario. Hypoglycemia would manifest with symptoms such as diaphoresis, tremors, and confusion, which are not mentioned. Hyperthyroidism symptoms include weight loss, heat intolerance, and palpitations, which are not consistent with the client's presentation.

5. What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?

• A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
• B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
• C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
• D. It regulates the threshold for water reabsorption in the kidneys.

Correct answer: C

Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.

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