Nokea
A 28-year-old primigravida with pregestational diabetes visits the clinic 6 weeks gestation. Which of the following statements indicates that she understands the nurse's teaching regarding her insulin needs during pregnancy?
- A. As the baby grows, I will need more insulin because the baby will not be able to make insulin.
- B. Changes in hormone levels will make my body more resistant to insulin, so I will need more insulin as the pregnancy progresses.
- C. As the baby grows, I will need less insulin because the baby uses up any extra glucose.
- D. If I maintain an adequate balance of diet and exercise, my insulin requirements will be the same.
Correct Answer: B
Rationale: Pregnancy hormones increase insulin resistance, requiring more insulin as pregnancy progresses in diabetic patients. Other statements are incorrect regarding insulin dynamics.
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A client has a chest tube inserted for treatment of a hemothorax.
Which of the following findings would indicate to the nurse that there is a problem with the effective functioning of the chest tube?
- A. 15-cm of water is present in the suction control chamber.
- B. Constant bubbling is observed in the water seal chamber.
- C. 2-cm of water is present in the water seal chamber.
- D. Clots of blood are observed in the collection chamber.
Correct Answer: B
Rationale: Strategy: Think about each answer choice. (1) appropriate, regulates the amount of suction delivered to the patient (2) correct-would indicate an air leak, would not allow negative pressure to be reestablished and would hinder complete resolution of the pneumothorax (3) appropriate, provides for a water seal (4) would be an expected finding
A client with end stage renal disease has been managed by peritoneal dialysis. Which finding should be reported to the doctor immediately?
- A. The amount of dialysate return is less than that instilled.
- B. The client complains of abdominal pain and nausea.
- C. The dialysate return is colorless in appearance.
- D. The client has lost two pounds in the last week.
Correct Answer: B
Rationale: Complaints of abdominal pain, nausea, fever, and return of cloudy dialysate should be reported to the physician since they are indications of peritonitis. Diminished or slow return of dialysate, as mentioned in answer A, is managed by having the client turn side to side or move about to facilitate return flow, so it is incorrect. Answers C and D are favorable findings that do not require intervention; therefore, they are incorrect.
The nurse is at the community center speaking with retired people about glaucoma. Which comment by one of the retirees would the nurse support to reinforce correct information?
- A. I usually avoid driving at night since lights sometimes seem to make things blur.'
- B. I take half of the usual dose for my sinuses to maintain my blood pressure.'
- C. I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem.'
- D. I take extra fiber and drink lots of water to avoid getting constipated.'
Correct Answer: D
Rationale: I take extra fiber and drink lots of water to avoid getting constipated.' Any activity that involves straining should be avoided in clients with glaucoma. Such activities would increase intraocular pressure.
The client has just had a basal cell carcinoma removed in the doctor's office. Which statement the client makes indicates understanding regarding prevention and early detection of basal cell carcinoma?
- A. Moles that are round and brown should be seen immediately by my doctor.'
- B. I should wear long sleeves when I am out in the sun.'
- C. I should avoid using lotions and powders on my skin.'
- D. I can use a tanning booth to get a tan since I can't stay in the sun very long.'
Correct Answer: B
Rationale: Long sleeves protect against UV exposure, a key risk for basal cell carcinoma. Moles, lotions, or tanning booths are unrelated or harmful.
The nurse is caring for a client with a history of glaucoma who is receiving timolol (Timoptic) eye drops. Which of the following client statements would be of GREATest concern to the nurse?
- A. I feel a burning sensation when I use the drops.
- B. My heart rate feels slower than usual.
- C. I have a headache in the morning.
- D. My eyes are watery sometimes.
Correct Answer: B
Rationale: Timolol, a beta-blocker, can cause systemic effects like bradycardia, and a slower heart rate is concerning, requiring evaluation to prevent cardiovascular complications. Options A, C, and D are less urgent: burning is common, headaches are nonspecific, and watery eyes are not significant.