Nokea
A client is admitted for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). Which breakfast selection by the client indicates effective learning?
- A. Scrambled eggs, bacon, one slice of whole wheat toast with butter and jam.
- B. Oatmeal with butter, artificial sweetener, and strawberries, and 6 ounces of coffee.
- C. Banana pancake with maple syrup, sausage links, half grapefruit, and low-fat milk.
- D. Orange juice, yogurt with berries, cold cereal with milk, bran muffin with margarine.
Correct Answer: B
Rationale: The correct answer is B. Oatmeal with butter, artificial sweetener, and strawberries is a suitable choice for a client with type 2 diabetes mellitus and chronic kidney disease as it provides a balanced meal that helps manage blood sugar levels and kidney function. Choice A contains high saturated fats and added sugars from bacon, butter, and jam, which are not ideal for this client. Choice C includes high sugar content from maple syrup and pancake, which can negatively impact blood sugar levels. Choice D contains high sugar content from orange juice and cold cereal, which can lead to blood sugar spikes, not suitable for a client with diabetes and CKD.
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A client with a history of angina pectoris is prescribed sublingual nitroglycerin. Which client statement indicates that further teaching is needed?
- A. 'I should take the nitroglycerin with a full glass of water.'
- B. 'I should take the nitroglycerin as soon as I feel chest pain.'
- C. 'I can take up to three doses of nitroglycerin if needed.'
- D. 'I should call 911 if my chest pain does not improve after the first dose.'
Correct Answer: A
Rationale: The correct answer is A. Sublingual nitroglycerin should not be taken with water, as it needs to dissolve under the tongue to be effective. Option B is correct as the client should take nitroglycerin as soon as they feel chest pain. Option C is correct as up to three doses can be taken if needed. Option D is correct as the client should seek emergency help if chest pain does not improve after the first dose.
A client with chronic renal failure (CRF) is placed on a protein-restricted diet. Which nutritional goal supports this dietary change?
- A. Reduce production of urea nitrogen (BUN)
- B. Decrease the risk of hyperkalemia
- C. Promote healing of injured nephrons
- D. Promote the elimination of albumin
Correct Answer: A
Rationale: The correct answer is A: Reduce production of urea nitrogen (BUN). A protein-restricted diet is essential for clients with chronic renal failure to decrease the production of urea nitrogen, as the kidneys cannot effectively excrete it. This helps in managing the accumulation of waste products in the body. Choices B, C, and D are incorrect. Choice B is not directly related to a protein-restricted diet but focuses on managing potassium levels. Choice C is not a direct nutritional goal of a protein-restricted diet but aims at supporting kidney function. Choice D is not a target of a protein-restricted diet but relates more to managing protein loss in the urine.
After a sudden loss of consciousness, a female client is taken to the ED, and the initial assessment indicates that her blood glucose level is critically low. Once her glucose level is stabilized, the client reports that she was recently diagnosed with anorexia nervosa and is being treated at an outpatient clinic. Which intervention is most important to include in this client's discharge plan?
- A. Describe the signs and symptoms of hypoglycemia.
- B. Encourage a low-carbohydrate and high-protein diet.
- C. Reinforce the need to continue outpatient treatment.
- D. Suggest wearing a medical alert bracelet at all times.
Correct Answer: B
Rationale: Encouraging a low-carbohydrate and high-protein diet is crucial for a client recovering from anorexia nervosa to prevent hypoglycemic episodes. Choice A is not the most important intervention at this point since the client is already aware of hypoglycemia based on the recent event. Choice C is important but not the priority in this situation where dietary intervention is crucial. Choice D, suggesting a medical alert bracelet, is not as essential as ensuring proper nutrition to prevent further hypoglycemic episodes.
The nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for hemodialysis. Which assessment finding is most concerning?
- A. Blood pressure of 110/70 mmHg
- B. Heart rate of 110 beats per minute
- C. Fever of 100.4°F
- D. Respiratory rate of 24 breaths per minute
Correct Answer: C
Rationale: A fever of 100.4°F is the most concerning assessment finding in a client with ESRD scheduled for hemodialysis. This elevation in temperature may indicate an underlying infection, which can lead to serious complications in individuals with compromised renal function. Prompt intervention is necessary to prevent the spread of infection and deterioration of the client's condition. The other vital signs mentioned, such as blood pressure, heart rate, and respiratory rate, while important to monitor, are within acceptable ranges and do not pose an immediate threat like a fever indicative of infection.
A newly graduated female staff nurse requests reassignment to another client because a male client is asking her for a date and making suggestive comments. Which response is best for the nurse manager to provide?
- A. I have to call the supervisor to get someone else to transfer to this unit to care for him.
- B. I know you are a good nurse and can handle this client in a professional manner.
- C. I'll talk to the client about his behavior and insist that he stop it immediately.
- D. I'll change your assignment, but let's talk about how a nurse should respond to this kind of client.
Correct Answer: D
Rationale: The best response for the nurse manager to provide in this situation is option D, which involves changing the assignment to address the nurse's immediate concern. It also offers an opportunity to have a conversation with the nurse about how to professionally handle such situations in the future. Option A is not the best response as it does not address the underlying issue and simply shifts the problem to another staff member. Option B, while supportive, does not actively address the client's inappropriate behavior. Option C is not ideal as the nurse manager should handle discussions about inappropriate behavior with clients themselves rather than delegating it to the staff nurse.