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A patient with acute congestive heart failure is receiving high doses of a diuretic. On assessment, the nurse notes flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. Suspecting hyponatremia, what additional signs would the nurse expect to note in this patient if hyponatremia were present?
- A. Dry skin
- B. Decreased urinary output
- C. Hyperactive bowel sounds
- D. Increased specific gravity of the urine
Correct Answer: C
Rationale: In a patient with hyponatremia, hyperactive bowel sounds are expected due to increased gastrointestinal motility. Dry skin (Choice A) is not a typical sign of hyponatremia. Decreased urinary output (Choice B) is more commonly associated with conditions like dehydration or renal issues, not specifically hyponatremia. Increased specific gravity of the urine (Choice D) is a sign of concentrated urine, which is not a characteristic finding in hyponatremia.
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A psychological contract exists between staff members and nurse managers. Which of the following best describes this relationship?
- A. Nurse managers provide positive evaluations, and in turn, staff members do what managers ask of them.
- B. Nurse managers coordinate multiple departments and supervise multiple staff members.
- C. Staff members do what managers ask of them and, in turn, are rewarded through assignments, promotions, and evaluations.
- D. Nurse managers advocate for staff and support nursing roles and ethical practice.
Correct Answer: C
Rationale: The correct answer is C. In a psychological contract between staff members and nurse managers, staff members are expected to fulfill the requests of managers, and in return, they are rewarded with assignments, promotions, and evaluations. This reciprocal relationship forms the basis of the psychological contract. Choices A, B, and D are incorrect because they do not accurately capture the essence of the psychological contract. While nurse managers may provide positive evaluations, coordinate departments, supervise staff, advocate for staff, and support nursing roles, these actions alone do not define the specific reciprocal nature of the psychological contract outlined in choice C.
The client with type 2 DM is learning to manage blood glucose levels. When should the client monitor blood glucose?
- A. Only when feeling unwell.
- B. Only before meals.
- C. Before meals and at bedtime.
- D. Only after meals.
Correct Answer: C
Rationale: The correct answer is to monitor blood glucose before meals and at bedtime. This timing allows the client to assess fasting levels and make informed decisions about mealtime insulin or medication doses. Monitoring only when feeling unwell (choice A) is not sufficient for proper glucose management as it may miss important trends. Monitoring only before meals (choice B) is helpful but does not provide a complete picture of the client's glucose control throughout the day. Monitoring only after meals (choice D) is less beneficial than monitoring before meals as it does not capture fasting levels. Therefore, monitoring before meals and at bedtime (choice C) is the most comprehensive approach to maintain good glucose control and prevent complications.
A client with type 2 DM is being treated with metformin (Glucophage). The nurse should include which instruction when teaching the client about this medication?
- A. Take the medication with meals.
- B. Take the medication on an empty stomach.
- C. Take the medication before bedtime.
- D. Avoid taking the medication if you miss a meal.
Correct Answer: A
Rationale: The correct instruction for a client taking metformin (Glucophage) is to take the medication with meals. This helps reduce gastrointestinal side effects and improves absorption. Choice B is incorrect because taking metformin on an empty stomach can increase the risk of side effects. Choice C is incorrect as there is no specific recommendation to take metformin before bedtime. Choice D is incorrect as missing a meal should not lead to avoiding the medication, but the client should take it with the next meal as prescribed.
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.
The healthcare provider is monitoring a client with Cushing's syndrome. Which of the following findings should be reported to the healthcare provider immediately?
- A. Hyperglycemia
- B. Hypertension
- C. Low-grade fever
- D. Weight gain
Correct Answer: C
Rationale: In a client with Cushing's syndrome, a low-grade fever should be reported immediately as it may indicate an infection. Clients with Cushing's syndrome are immunosuppressed, making them more susceptible to infections. Hyperglycemia and hypertension are common findings in Cushing's syndrome and are managed as part of the condition. Weight gain is also a common symptom in Cushing's syndrome and may not require immediate reporting unless it is sudden and severe.