Nursing Elites

1. The client with DM is being taught about foot care. The nurse instructs the client to:

• A. Avoid hot water when bathing the feet.
• B. Apply a moisturizing lotion to the feet, especially between the toes.
• C. Use a heating pad to warm the feet if they feel cold.
• D. Go barefoot at home to allow the feet to air out.

Correct answer: A

Rationale: The correct answer is to avoid hot water when bathing the feet. This instruction is crucial because clients with diabetes may have decreased sensation in their feet, which can put them at risk of burns from hot water. Choice B is incorrect because applying moisturizing lotion between the toes can increase moisture and promote fungal growth. Choice C is incorrect because using a heating pad can also lead to burns due to decreased sensation. Choice D is incorrect as going barefoot can increase the risk of injury and infections in clients with diabetes.

2. 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.

3. The client with DM who is taking insulin develops a fever and becomes confused. Which action should the nurse take first?

• A. Check the client's blood glucose level.
• B. Administer a fever-reducing medication.
• C. Give the client fluids to drink.
• D. Notify the health care provider.

Correct answer: A

Rationale: In a client with diabetes mellitus (DM) taking insulin, the development of fever and confusion may indicate hyperglycemia or diabetic ketoacidosis. Checking the blood glucose level is the priority action in this situation. This will help determine if the symptoms are related to high blood sugar levels, guiding further interventions. Administering a fever-reducing medication (choice B) addresses only the symptom of fever and does not address the underlying cause. Providing fluids to drink (choice C) is important but should come after addressing the potential hyperglycemia or diabetic ketoacidosis. Notifying the health care provider (choice D) can be important, but immediate action to evaluate and manage the client's condition should precede contacting the provider.

4. A nurse manager is reviewing the nurse’s documentation on the unit. Which of the following best describes the importance of this review?

• A. The nurse manager’s review of documentation is crucial to ensure that it meets legal and ethical standards and accurately reflects the care provided to patients.
• B. The nurse manager’s review of documentation is important to ensure that it is thorough, accurate, and reflects the nurse’s accountability for patient care.
• C. The nurse manager’s review of documentation is necessary to ensure that it is consistent with the unit’s policies and procedures and that it accurately reflects the care provided.
• D. The nurse manager’s review of documentation is essential to ensure that it meets regulatory requirements and that it supports the delivery of safe and effective patient care.

Correct answer: D

Rationale: The nurse manager's review of documentation is a critical aspect of maintaining quality patient care. Choice D is the correct answer as it highlights the importance of ensuring that documentation meets regulatory requirements, supporting the delivery of safe and effective patient care. Regulatory requirements are established to ensure that healthcare facilities function within established guidelines and standards, promoting patient safety and quality of care. Choices A, B, and C, although important aspects of documentation review, do not fully encapsulate the significant role of regulatory compliance in ensuring the overall quality and safety of patient care.

5. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

• A. 2-4 hours after administration
• B. 6-14 hours after administration
• C. 16-18 hours after administration
• D. 18-24 hours after administration

Correct answer: B

Rationale: The correct answer is B: 6-14 hours after administration. NPH insulin has an onset of action within 1-2 hours, a peak action at 6-14 hours, and a duration of action of 16-24 hours. The peak action period, which is when the risk of hypoglycemia is highest, falls between 6-14 hours after administration. Choices A, C, and D are incorrect because they do not align with the typical action profile of NPH insulin.

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