Nokea
A friend brings the older adult homeless client to a free health screening clinic. The friend is unable to continue administering the client's morning and evening insulin dose for treating type 1 DM. When advocating for this client, which action by the nurse is most appropriate?
- A. Notify Adult Protective Services about the client's condition and living situation.
- B. Ask where the client lives and whether someone else could administer the insulin.
- C. Arrange with a local homeless shelter to have someone give the insulin injections.
- D. Have the client return to the screening clinic morning and evening to receive the injections.
Correct Answer: C
Rationale: The nurse advocates by ensuring that the client has access to health care services. The nurse should contact a social worker whose role it is to make placement arrangements.
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The nurse is reviewing serum laboratory results for four female clients. Place an X on the client requiring the most immediate assessment.
- A. Client A: TSH 5.2 mIU/L, Free T4 0.8 ng/dL
- B. Client B: GH 23 µg/L, IGF-I 490 ng/mL
- C. Client C: Free T4 7.0 ng/dL, TSH 0.1 mIU/L
- D. Client D: Fasting glucose 140 mg/dL, Hgb A1c 6.9%
Correct Answer: C
Rationale: Client C has elevated free T4 and decreased TSH, indicating hyperthyroidism, which can lead to life-threatening thyroid storm with severe hypertension and tachycardia, requiring immediate assessment.
The nurse is teaching the client newly diagnosed with type 2 DM. Which information should the nurse emphasize in the session?
- A. Use the arm when self-administering insulin.
- B. Exercise for 30 minutes daily, preferably after a meal.
- C. Consume 30% of the daily calorie intake from protein foods.
- D. Eat a 30-gram carbohydrate snack prior to strenuous activity.
Correct Answer: B
Rationale: Exercise increases insulin receptor sites in the tissue and can have a direct effect on lowering blood glucose levels. Exercise contributes to weight loss, which also decreases insulin resistance.
The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider?
- A. Serum sodium of 112 mEq/L and a headache.
- B. Serum potassium of 5.0 mEq/L and a heightened awareness.
- C. Serum calcium of 10 mg/dL and tented tissue turgor.
- D. Serum magnesium of 1.2 mg/dL and large urinary output.
Correct Answer: A
Rationale: Severe hyponatremia (112 mEq/L) and headache in SIADH risk seizures, requiring immediate HCP notification. Other findings are less critical or unrelated.
The nurse is teaching the client who lacks parathyroid hormone (PTH) about foods to consume. Which items should be included on a list of appropriate foods for the client?
- A. Dark green vegetables, soybeans, and tofu
- B. Spinach, strawberries, and yogurt
- C. Whole grain bread, milk, and liver
- D. Rhubarb, yellow vegetables, and fish
Correct Answer: A
Rationale: High-calcium foods like dark green vegetables, soybeans, and tofu are appropriate for hypoparathyroidism to address chronic hypocalcemia.
The nurse is caring for clients on a medical floor. Which client should be assessed first?
- A. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday.
- B. The client diagnosed with a pituitary tumor who has developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours.
- C. The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having muscle twitching.
- D. The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night.
Correct Answer: C
Rationale: Muscle twitching in SIADH suggests hyponatremia-induced neurological symptoms, requiring immediate assessment. Weight gain, slight DI output imbalance, and tiredness are less urgent.