Nursing Elites

1. When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery.
• B. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
• C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
• D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

Correct answer: C

Rationale: The correct answer is C because the administration of prescribed lispro (Humalog) insulin before transporting the patient to surgery is a task that can be safely delegated to a licensed practical/vocational nurse (LPN/LVN). This action is within the scope of practice of an LPN/LVN and does not require independent nursing judgment. Choices A and B involve communicating and discussing important medical information, which are higher-level nursing actions typically performed by registered nurses. Choice D involves planning strategies to manage blood glucose levels postoperatively, which requires critical thinking and assessment skills usually performed by a registered nurse.

2. The nurse determines a need for additional instruction when the patient with newly diagnosed type 1 diabetes says which of the following?

• A. �I can have an occasional alcoholic drink if I include it in my meal plan.�
• B. �I will need a bedtime snack because I take an evening dose of NPH insulin.�
• C. �I can choose any foods, as long as I use enough insulin to cover the calories.�
• D. �I will eat something at meal times to prevent hypoglycemia, even if I am not hungry.�

Correct answer: C

Rationale:

3. Which of the following is an example of a tertiary prevention strategy?

• A. Administering childhood vaccinations
• B. Chemotherapy for cancer treatment
• C. Routine screening for hypertension
• D. Physical therapy for stroke rehabilitation

Correct answer: D

Rationale: The correct answer is D: Physical therapy for stroke rehabilitation. Tertiary prevention aims to prevent complications and manage existing conditions to improve the quality of life. Administering childhood vaccinations (A) is an example of primary prevention to prevent the onset of diseases. Chemotherapy for cancer treatment (B) is a form of secondary prevention focusing on early detection and treatment to stop the progression of the disease. Routine screening for hypertension (C) is also a form of secondary prevention to detect and treat hypertension early, preventing further complications.

4. Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

• A. The patient�s blood glucose level is 174 mg/dL.
• B. The patient has gained 2 lb (0.9 kg) since yesterday.
• C. The patient is scheduled for a chest x-ray in an hour
• D. The patient�s blood urea nitrogen (BUN) level is 52 mg/dL.

Correct answer: D

Rationale:

5. For a 55-year-old female patient with type 2 diabetes and a nursing diagnosis of imbalanced nutrition: more than body requirements, which goal is most important?

• A. The patient will reach a glycosylated hemoglobin level of less than 7%.
• B. The patient will follow a diet and exercise plan that results in weight loss.
• C. The patient will choose a diet that distributes calories throughout the day.
• D. The patient will state the reasons for eliminating simple sugars in the diet.

Correct answer: A

Rationale: The most important goal for a 55-year-old female patient with type 2 diabetes and imbalanced nutrition due to more than body requirements is to reach a glycosylated hemoglobin level of less than 7%. This goal directly addresses the management of diabetes and is crucial in preventing complications associated with high blood sugar levels. Choice B focuses on weight loss, which may be beneficial but is not as critical as controlling blood sugar levels. Choice C, distributing calories throughout the day, is important for glycemic control but not as immediate as reaching a target HbA1c level. Choice D, stating the reasons for eliminating simple sugars, is a good educational goal but not as urgent as achieving glycemic control.

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