Nokea
A client has recently been diagnosed with type 2 diabetes mellitus and is to take tolbutamide (Orinase). When teaching the client about the drug, the nurse explains that tolbutamide is believed to lower the blood glucose level by which of the following actions?
- A. Potentiating the action of insulin.
- B. Lowering the renal threshold of glucose.
- C. Stimulating insulin release from functioning beta cells in the pancreas.
- D. Combining with glucose to render it inert.
Correct Answer: C
Rationale: Tolbutamide, a sulfonylurea, stimulates insulin release from pancreatic beta cells, helping to lower blood glucose levels in type 2 diabetes.
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A nurse is making follow-up phone calls to clients being treated for cancer. Place the options below in the order of priority that the nurse should return the calls.
- A. The client receiving chemotherapy who complains of a loss of appetite.
- B. The client who underwent a mastectomy 2 weeks ago who called for information on the Reach for Recovery program.
- C. The client receiving spinal radiation for bone cancer metastases who complains of urinary incontinence.
- D. The client with colon cancer who has questions about a high-fiber diet.
Correct Answer: C,A,B,D
Rationale: Urinary incontinence (C) may indicate a serious complication like spinal cord compression, requiring immediate attention. Loss of appetite (A) during chemotherapy can lead to malnutrition, followed by the mastectomy client's support needs (B), and then dietary questions (D).
The nurse should ask all clients age 65 or older who are having surgery which question?
- A. Do you have Medicare Part A to help pay for the hospital reimbursement?'
- B. œDo you have an advance directive such as a health care proxy or living will?'
- C. œDo you have extra coverage to help pay for medications?'
- D. œDo you have Medicare Part B to help pay for your expenses?'
Correct Answer: B
Rationale: Asking about an advance directive ensures the client's wishes are documented, especially critical for older adults facing surgical risks, to guide care in case of incapacity.
A client is receiving an I.V. infusion of 5% dextrose in water (D5W). The skin around the I.V. insertion site is red, warm to touch, and painful. The nurse should first:
- A. Administer acetaminophen (Tylenol)
- B. Change the D5W to normal saline
- C. Discontinue the I.V.
- D. Place a warm compress on the area
Correct Answer: C
Rationale: Redness, warmth, and pain at the I.V. site indicate phlebitis or infiltration. The first action is to discontinue the I.V. to prevent further tissue damage. Changing fluids, applying a compress, or giving acetaminophen does not address the immediate issue.
The family cannot go with the surgical client past the doors that separate the public from the restricted area of the operating room suite. These traffic control measures are designed to:
- A. Protect the privacy of clients.
- B. Prevent electrical sparks that could ignite the anesthetic gases.
- C. Separate the family from the surgical team to prevent distraction of the client.
- D. Provide for an aseptic environment to prevent infection.
Correct Answer: D
Rationale: Restricting access to the operating room maintains an aseptic environment, reducing the risk of surgical site infections by limiting contamination.
The nurse is assessing a client with drooping of their left eyelid. The nurse documents this finding as
- A. mydriasis.
- B. ptosis.
- C. presbyopia.
- D. hyphema.
Correct Answer: B
Rationale: Ptosis is the medical term for drooping of the eyelid. Mydriasis refers to pupil dilation, presbyopia is age-related vision loss, and hyphema is blood in the anterior chamber of the eye.