Nokea
A 45-year-old client with newly diagnosed IDDM (insulin-dependent diabetes mellitus) is being seen by the home health nurse. The physician has placed him on a 1,800-calorie ADA diet, ordered the client to self-administer 15 units of NPH insulin each day before breakfast, and check his blood sugar qid. When the nurse visits the client at 5 PM, the nurse discovers that the client has not eaten since noon and has just returned from jogging. The client's vital signs are: BP 110/80, pulse 120, respirations 18, temperature 98.2°F (36.8°C). When the client obtains his blood sugar reading, the nurse would expect it to be?
- A. 250 mg/dL.
- B. 160 mg/dL.
- C. 90 mg/dL.
- D. 50 mg/dL.
Correct Answer: D
Rationale: hypoglycemia symptoms are cool, clammy skin, diaphoresis, nervousness, weakness, hunger, confusion, headache, slurred speech, coma
You may also like to solve these questions
The nurse is observing a student nurse auscultate the lungs of a client. The nurse knows that the student nurse is correctly auscultating the right middle lobe (RML) if the stethoscope is placed in which of the following positions?
- A. Posterior and anterior base of right side.
- B. Right anterior chest between the fourth and sixth intercostals.
- C. Left of the sternum, midclavicular, at right fifth intercostal.
- D. Posterior chest wall, midaxillary, right side.
Correct Answer: B
Rationale: RML is found in the right anterior chest between the fourth and sixth intercostal spaces
The nurse is teaching a client with chronic kidney disease about sevelamer (Renagel). Which of the following instructions should the nurse include?
- A. Take the medication with meals.
- B. Stop the medication if phosphate levels are normal.
- C. Avoid reporting constipation.
- D. Take the medication with calcium supplements.
Correct Answer: A
Rationale: Sevelamer binds phosphate during meals, reducing absorption. Options B, C, and D are incorrect.
A young child is placed on droplet precautions. The nurse is caring for which of the following clients?
- A. A child with cystic fibrosis.
- B. A child with tonsillitis.
- C. A child with bronchitis.
- D. A child with pertussis.
Correct Answer: D
Rationale: droplet precautions required, private room, maintain spatial separation of 3 feet between patient and visitors
The nurse is obtaining a history on a client with hyperthyroidism. The nurse should report which of the following assessments to the physician?
- A. Anxiety with extreme nervousness.
- B. Slow, sluggish pulse.
- C. Cool, clammy skin.
- D. Husky, slow speech.
Correct Answer: A
Rationale: signs and symptoms of hyperthyroidism are related to an increased metabolic rate
A patient is returned from surgery with a Jackson-Pratt drain in place. The nurse observes a student nurse perform a dressing change for the patient.
Which of the following activities if performed by the student nurse would require an intervention by the nurse?
- A. Documents the amount and character of the drainage in the patient's chart.
- B. Attaches the drain to the top sheet on the bed.
- C. Empties the reservoir of the drain.
- D. Records the amount of drainage on the output sheet.
Correct Answer: B
Rationale: Strategy: 'Require an intervention' indicates an incorrect response. (1) drains used to prevent wound infections and abscess formation (2) correct-drain should be attached to patient's gown or pajamas, never to the sheet or mattress (3) Jackson-Pratt drain is a self-contained suction device that is emptied as needed (4) important to monitor output