Nokea
A post-adrenalectomy client is admitted to the intensive care unit and is on intravenous hydrocortisone. Which nursing intervention should be included in the client's plan of care?
- A. Monitor blood glucose levels frequently
- B. Keep the client supine for 24 hours
- C. Discontinue hydrocortisone once vital signs become stable
- D. Educate the client on how to properly clean the wound at home
Correct Answer: A
Rationale: Adrenalectomy removes cortisol production; hydrocortisone replacement can raise glucose. Frequent monitoring prevents hyperglycemia. Keeping supine is unnecessary, discontinuation risks adrenal crisis, and wound care education is premature in ICU.
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The nurse is preparing to administer metformin to a client with diabetes mellitus (type two). Which of the following laboratory test results should the nurse monitor during the therapy?
- A. white blood cell (WBC) count
- B. vitamin B12 level
- C. serum uric acid level
- D. thyroid-stimulating hormone (TSH) level
Correct Answer: B
Rationale: Metformin can cause vitamin B12 deficiency over time, requiring monitoring. WBC, uric acid, and TSH are not primarily affected by metformin.
The nurse plans care for a client experiencing a hyperglycemic-hyperosmolar state (HHS). The nurse should anticipate which prescriptions from the primary healthcare provider (PHCP)?
- A. 0.9% saline infusion
- B. Glargine insulin
- C. Sodium polystyrene
- D. Sodium bicarbonate
Correct Answer: A
Rationale: HHS involves severe hyperglycemia and dehydration. 0.9% saline corrects fluid loss. Glargine is long-acting and not ideal for acute HHS, sodium polystyrene treats hyperkalemia, and bicarbonate is rarely used unless pH is critically low.
The nurse is caring for a client who reports diarrhea, unintentional weight loss, and nervousness. The primary healthcare provider (PHCP) orders a thyroid panel, and the nurse understands the client is at the highest risk for
- A. Myxedema
- B. Bell's palsy
- C. Grave's disease
- D. Cushing syndrome
Correct Answer: C
Rationale: Diarrhea, weight loss, and nervousness suggest hyperthyroidism, with Graves' disease as the most common cause due to thyroid overstimulation. Myxedema and Cushing's have opposite symptoms, and Bell's palsy is unrelated.
The nurse is teaching a review course on foods appropriate to treat hypoglycemia. It indicates appropriate understanding if an attendee states that which item should be provided?
- A. Slice of chicken breast
- B. 1 tablespoon of honey
- C. 1/2 cup of regular soda
- D. 1/2 cup of juice
- E. Two hardboiled eggs
Correct Answer: B, C, D
Rationale: Hypoglycemia requires fast-acting carbs: honey, regular soda, and juice raise glucose quickly. Protein-rich chicken and eggs are slow to digest and not effective for acute treatment.
The nurse is assisting a client with their newly prescribed insulin pump. The nurse understands which insulin is commonly loaded into the pump?
- A. Rapid acting
- B. Ultra long-acting insulin
- C. Intermediate acting
- D. Long acting
Correct Answer: A
Rationale: Rapid-acting insulin, such as lispro or aspart, is used in insulin pumps to mimic physiological insulin delivery for basal and bolus dosing. Long-acting or intermediate-acting insulins are not suitable for pumps.