Nokea
For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?
- A. They contain exudate and provide a moist wound environment.
- B. They protect the wound from mechanical trauma and promote healing.
- C. They debride the wound and promote healing by secondary intention.
- D. They prevent the entrance of microorganisms and minimize wound discomfort.
Correct Answer: C
Rationale: Wet-to-dry dressings are utilized in this case to debride the wound by removing dead tissue and promoting healing by secondary intention. Choice A is incorrect as wet-to-dry dressings do not provide a moist wound environment; instead, they promote drying to aid in debridement. Choice B is incorrect because their primary purpose is not to protect the wound but to remove dead tissue. Choice D is incorrect as the main function of wet-to-dry dressings is not to prevent the entrance of microorganisms or minimize wound discomfort.
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The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following interventions should the nurse implement?
- A. Encourage increased fluid intake
- B. Administer vasopressin
- C. Monitor for signs of dehydration
- D. Restrict oral fluids
Correct Answer: D
Rationale: The correct intervention for a client with syndrome of inappropriate antidiuretic hormone (SIADH) is to restrict oral fluids. SIADH leads to excessive release of antidiuretic hormone (ADH), causing the body to retain water and diluting the sodium levels in the blood (hyponatremia). Restricting oral fluids helps prevent further water retention and worsening hyponatremia. Encouraging increased fluid intake (choice A) would exacerbate the problem by further diluting sodium levels. Administering vasopressin (choice B) is not indicated in SIADH, as the condition is characterized by excess ADH secretion. Monitoring for signs of dehydration (choice C) is not the priority in SIADH since the issue is water retention rather than dehydration.
What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?
- A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
- B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
- C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
- D. It regulates the threshold for water reabsorption in the kidneys.
Correct Answer: C
Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.
A client with DM is scheduled to have surgery. The nurse should plan to:
- A. Give the client a regular diet as ordered.
- B. Hold the client's insulin on the morning of surgery.
- C. Monitor the client's blood glucose level closely during the perioperative period.
- D. Have the client stop taking insulin 48 hours before surgery.
Correct Answer: C
Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. This is essential to ensure that the client's blood glucose levels remain within the target range and to prevent complications such as hypo- or hyperglycemia. Choices A, B, and D are incorrect because giving a regular diet as ordered, holding insulin on the morning of surgery, or stopping insulin 48 hours before surgery can lead to uncontrolled blood glucose levels, posing risks to the client's safety during the surgical procedure.
A client with DM is scheduled for surgery. The nurse should plan to:
- A. Monitor the client's blood glucose level closely during the perioperative period.
- B. Give the client a regular diet as ordered.
- C. Have the client stop taking insulin 48 hours before surgery.
- D. Hold the client's insulin on the morning of surgery.
Correct Answer: A
Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. For a client with diabetes mellitus (DM) scheduled for surgery, it is essential to closely monitor blood glucose levels to prevent hypo- or hyperglycemia. Choice B is incorrect because giving the client a regular diet as ordered may not address the specific needs related to managing blood glucose levels in the perioperative period. Choice C is incorrect as abruptly stopping insulin 48 hours before surgery can lead to uncontrolled blood sugar levels, which is not recommended. Choice D is incorrect because holding the client's insulin on the morning of surgery can also disrupt blood sugar control, potentially leading to complications during the perioperative period.
In a client with hypoparathyroidism, the nurse should expect which laboratory result?
- A. Increased calcium levels
- B. Decreased phosphorus levels
- C. Increased phosphorus levels
- D. Increased potassium levels
Correct Answer: C
Rationale: In hypoparathyroidism, there is a deficiency of parathyroid hormone, leading to decreased calcium levels and increased phosphorus levels. Therefore, the correct answer is 'Increased phosphorus levels' (Choice C). Choice A, 'Increased calcium levels,' is incorrect because hypoparathyroidism is associated with low calcium levels. Choice B, 'Decreased phosphorus levels,' is incorrect as phosphorus levels are typically elevated in hypoparathyroidism. Choice D, 'Increased potassium levels,' is not directly related to hypoparathyroidism and is not an expected laboratory result in this condition.