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The nurse is caring for multiple clients with DM. It is most important for the nurse to initiate a referral to a diabetes educator for which client?
- A. The client who states diabetes is well controlled with diet and exercise; Hgb A1c is 11%.
- B. The client requesting diabetes information; fingerstick glucose is 132 mg/dL, Hgb A1c is 5.6%.
- C. The client who states perfect compliance with diet, exercise, and meds; Hgb A1c is 7%.
- D. The client with short-term memory loss; fingerstick glucose is 110 mg/dL, Hgb A1c is 4.5%.
Correct Answer: A
Rationale: It is most important for the nurse to initiate a referral for clients who falsely think their diabetes is well controlled. The client's Hgb A1c, which measures average blood glucose over the previous 3 months, is 11%, indicating that the diabetes is not well controlled.
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The client taking NPH insulin at 0800 reports feeling anxious and shaky in the midafternoon. Which intervention is best for the nurse to initiate?
- A. Have the client rate the level of anxiety.
- B. Give the client's prn dose of lorazepam.
- C. Check the client's fingerstick blood glucose level.
- D. Advise the client to sit in a recliner to relax.
Correct Answer: C
Rationale: The best intervention is to check a fingerstick blood glucose level because anxiety and shakiness in the midafternoon when taking NPH insulin could indicate hypoglycemia; NPH insulin peaks in 6-8 hours after administration.
The nursing assistant reports to the nurse that the client's blood glucose reading is 58 mg/dL. What is the most appropriate nursing action at this time?
- A. The nurse is the need to be a condition.
- B. Give the client 1/4 cup of sweet fruit juice.
- C. Report the client's symptoms to the physician.
- D. Perform a complete head-to-toe assessment.
Correct Answer: B
Rationale: A blood glucose of 58 mg/dL with symptoms indicates hypoglycemia, requiring immediate administration of a fast-acting carbohydrate like fruit juice.
The nurse is discussing the importance of exercising with a client diagnosed with type 2 diabetes whose diabetes is well controlled with diet and exercise. Which information should the nurse include in the teaching about diabetes?
- A. Eat a simple carbohydrate snack before exercising.
- B. Carry peanut butter crackers when exercising.
- C. Encourage the client to walk 20 minutes three (3) times a week.
- D. Perform warm-up and cool-down exercises.
Correct Answer: D
Rationale: Warm-up and cool-down exercises prevent injury during exercise, crucial for type 2 diabetics. Pre-exercise snacks are for insulin users, peanut butter is high-fat, and walking is good but not the focus.
The client is diagnosed with hypothyroidism. Which assessment data support this diagnosis?
- A. The client's vital signs are: T 99.0, P 110, R 26, and BP 145/80.
- B. The client complains of constipation and being constantly cold.
- C. The client has an intake of 780 mL and output of 256 mL.
- D. The client complains of a headache and has projectile vomiting.
Correct Answer: B
Rationale: Constipation and cold intolerance are classic hypothyroidism symptoms due to slowed metabolism. Tachycardia/hypertension, fluid imbalance, and vomiting are unrelated.
When the nurse reviews the client's history, which assessment finding is closely associated with the client's diagnosis?
- A. Nightly leg cramps
- B. Recurrent kidney stones
- C. Loose bowel movements
- D. Excessive energy level
Correct Answer: B
Rationale: Hyperparathyroidism causes hypercalcemia, which can lead to recurrent kidney stones.