Nokea
Which of the following are appropriate nursing interventions for the patient in myxedema coma? (Select all that apply.)
- A. Administer levothyroxine as prescribed.
- B. Encourage the intake of foods high in sodium.
- C. Initiate passive rewarming interventions.
- D. Monitor airway and respiratory effort.
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Administering levothyroxine is crucial in treating myxedema coma as it helps replace the deficient thyroid hormone.
2. This intervention addresses the underlying cause of myxedema coma, which is severe hypothyroidism.
3. Levothyroxine administration can help reverse the symptoms of myxedema coma and improve the patient's condition.
Summary of Incorrect Choices:
- B: Encouraging high sodium intake is not appropriate as myxedema coma is associated with fluid retention and sodium may exacerbate this.
- C: Passive rewarming interventions are not relevant for myxedema coma, as the condition is not typically related to hypothermia.
- D: While monitoring airway and respiratory effort is important in general patient care, it is not a specific intervention for myxedema coma.
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A patient is receiving hydrocortisone sodium succinate for adrenal crisis. What other medication does the nurse prepare to administer?
- A. Regular insulin
- B. A proton pump inhibitor
- C. Canagliflozin
- D. Propranolol
Correct Answer: B
Rationale: The correct answer is B: A proton pump inhibitor. When a patient is receiving hydrocortisone for adrenal crisis, it can lead to increased gastric acid secretion. A proton pump inhibitor helps reduce acid production and prevents gastric ulcers. Regular insulin (A) is not typically indicated in this scenario. Canagliflozin (C) is a medication used for diabetes management and is not relevant here. Propranolol (D) is a beta-blocker and may mask signs of hypoglycemia when used with insulin, which is not suitable in this case.
Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?
- A. An 18-year-old college student with type 1 diabetes who exercises excessively
- B. A 45-year-old woman with type 1 diabetes who forgets to take her insulin in the morning
- C. A 75-year-old man with type 2 diabetes and coronary artery disease who has recently started on insulin injections
- D. An 83-year-old, long-term care resident with type 2 diabetes and advanced Alzheimer’s disease who recently developed influenza
Correct Answer: D
Rationale: The correct answer is D because the 83-year-old long-term care resident with type 2 diabetes and advanced Alzheimer's disease who recently developed influenza is at the highest risk for hyperosmolar hyperglycemic syndrome (HHS). This patient has multiple risk factors for HHS, including age, type 2 diabetes, advanced Alzheimer's disease, and the added stress of influenza, which can exacerbate hyperglycemia. The combination of these factors can lead to severe hyperglycemia, dehydration, and electrolyte imbalances characteristic of HHS.
Choice A is incorrect because although excessive exercise can lead to hypoglycemia in individuals with type 1 diabetes, it is not a risk factor for HHS. Choice B is incorrect as forgetting to take insulin can lead to diabetic ketoacidosis in type 1 diabetes, not HHS. Choice C is incorrect as starting insulin injections in a patient with type 2 diabetes and coronary artery disease does not automatically increase the risk
What psychosocial factors may potentially contribute to the development of diabetic ketoacidosis? (Select all that apply.)
- A. Altered sleep/rest patterns
- B. Eating disorder
- C. Exposure to influenza
- D. High levels of stress
Correct Answer: A
Rationale: Rationale for correct answer A: Altered sleep/rest patterns can disrupt insulin regulation, leading to glucose imbalance and predisposing to diabetic ketoacidosis. Lack of sleep affects hormones that regulate blood sugar levels, increasing the risk of DKA.
Summary of why other choices are incorrect:
B: Eating disorder can affect blood sugar control but is not a direct cause of DKA.
C: Exposure to influenza may trigger stress on the body but is not a psychosocial factor contributing to DKA.
D: High levels of stress can impact blood sugar levels but are not specific psychosocial factors leading to DKA.
The nurse is providing insulin education for an elderly patient with long-standing
diabetes. A prescription has been written for the patient to take 20 units of insulin glargine at 10
PM nightly. The nurse should instruct the patient that the peak of the insulin action for this agent
is
- A. 200
- B. 400
- C. 800
- D. peakless
Correct Answer: D
Rationale: The correct answer is D: peakless. Insulin glargine is a long-acting insulin with a smooth, consistent release of insulin over 24 hours, providing a steady level of insulin without a pronounced peak. This characteristic helps in maintaining stable blood glucose levels. Options A, B, and C are incorrect as they refer to peak values that do not apply to insulin glargine.
A patient with long-standing type 1 diabetes presents to the emergency department with a loss of consciousness and seizure activity. The patient has a history of renal insufficiency, gastroparesis, and peripheral diabetic neuropathy. Emergency personnel reported a blood glucose of 32 mg/dL on scene. When providing discharge teaching for this patient and family, the nurse instructs on the need to do which of the following? (Select all that apply.)
- A. Administer glucagon 1 mg intramuscularly any time the blood glucose is less than 70 mg/dL.
- B. Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia.
- C. Discontinue the insulin pump by removing the infusion set catheter.
- D. Increase home blood glucose monitoring and report patterns of hypoglycemia to the provider.
Correct Answer: B
Rationale: The correct answer is B: Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia. In this scenario, the patient is experiencing severe hypoglycemia (blood glucose of 32 mg/dL) leading to loss of consciousness and seizure activity. Administering 15 grams of carbohydrate orally is crucial to rapidly raise the blood glucose levels and address the hypoglycemia. This immediate intervention can help reverse the symptoms and prevent further complications.
The incorrect choices:
A: Administering glucagon intramuscularly is typically reserved for severe hypoglycemia when the patient cannot take anything by mouth. In this case, oral intake is preferred for faster absorption.
C: Discontinuing the insulin pump is not necessary in this situation since the primary concern is treating the acute hypoglycemia. Removing the infusion set can lead to hyperglycemia if not managed properly.
D: Increasing home blood glucose monitoring and reporting patterns of hyp