Nokea
Regular insulin by continuous intravenous (IV) infusion is prescribed for a client with diabetes mellitus who has a blood glucose level of 700 mg/dL (40 mmol/L). How should the nurse administer this medication safely?
- A. Mix the solution in 5% dextrose.
- B. Change the solution every 6 hours.
- C. Infuse the medication via an electronic infusion pump.
- D. Titrate the infusion according to the client's urine glucose levels.
Correct Answer: C
Rationale: Insulin is administered via an infusion pump to prevent inadvertent overdose and subsequent hypoglycemia. Dextrose is added to the IV infusion once the serum glucose level reaches 250 mg/dL (14.2 mmol/L) to prevent the occurrence of hypoglycemia. Administering dextrose to a client with a serum glucose level of 700 mg/dL would counteract the beneficial effects of insulin in reducing the glucose level. There is no reason to change the solution every 6 hours. Glycosuria is not a reliable indicator of the actual serum glucose levels because many factors affect the renal threshold for glucose loss in the urine.
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Which statements describe characteristics of case management? Select all that apply.
- A. A case manager usually does not provide direct care.
- B. Critical pathways and CareMaps are types of case management.
- C. A case manager does not need to be concerned with standards of cost management.
- D. A case manager collaborates with and supervises the care delivered by other staff members.
- E. The evaluation process involves continuous monitoring and analysis of the needs of the client and services provided.
- F. A case manager coordinates a hospitalized client's acute care and follows up with the client after discharge to home.
Correct Answer: A,D,E,F
Rationale: Case management is a care management approach that coordinates health care services to clients and their families while maintaining quality of care and minimizing health care costs. Case managers usually do not provide direct care; instead, they collaborate with and supervise the care delivered by other staff members and actively coordinate client discharge planning. A case manager is usually held accountable for some standard of cost management. A case manager coordinates a hospitalized client's acute care, follows up with the client after discharge to home, and is responsible and accountable for appraising the overall usefulness and effectiveness of the case-managed services. This evaluation process involves continuous monitoring and analysis of the client's needs and services provided. Critical pathways or CareMaps are not types of case management; rather, they are multidisciplinary treatment plans used in a case management delivery system to implement timely interventions in a coordinated care plan.
The nurse caring for a chronically ill client with a poor prognosis shows an understanding of the basic values that guide the implementation of a living will by asking which questions? Select all that apply.
- A. Are you planning to become an organ donor?
- B. Do you feel the need to discuss your end-of-life decisions with your family?
- C. Did you have the discussion with your son about being your health care surrogate?
- D. Can we discuss what will happen if you decide to refuse antibiotics if you get an infection?
- E. Have you given thought to whether you want cardiopulmonary resuscitation (CPR) measures if your condition worsens?
Correct Answer: B,D,E
Rationale: A living will lists the treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill. The client may want to discuss her or his decisions with the family. Although both the living will and durable powers of attorney for health care are based on values of informed consent, autonomy over end-of-life decisions, and control over the dying process, living wills do not involve health care surrogates or the decision to donate organs.
The nurse is about to administer a prescribed intravenous dose of tobramycin when the client reports vertigo and ringing in the ears. Which action should the nurse take next?
- A. Check the client's pupillary responses.
- B. Hang the dose of medication immediately.
- C. Give a dose of droperidol with the tobramycin.
- D. Hold the dose and call the primary health care provider (HCP).
Correct Answer: D
Rationale: Tobramycin is an antibiotic (aminoglycoside). Ringing in the ears and vertigo are two symptoms that may indicate dysfunction of the eighth cranial nerve. The nurse should hold the dose and notify the HCP. Ototoxicity is a toxic effect of therapy with aminoglycosides and could result in permanent hearing loss. There is no need to check the pupillary response. Administering the dose would be an unsafe response.
The nurse is developing an educational session on client advocacy for the nursing staff. The nurse should include which interventions as examples of the nurse acting as a client advocate? Select all that apply.
- A. Obtaining an informed consent for a surgical procedure
- B. Providing information necessary for a client to make informed decisions
- C. Providing assistance in asserting the client's human and legal rights if the need arises
- D. Including the client's religious or cultural beliefs when assisting the client in making an informed decision
- E. Defending the client's rights by speaking out against policies or actions that might endanger the client's well-being
Correct Answer: B,C,D,E
Rationale: In the role of client advocate, the nurse protects the client's human and legal rights and provides assistance in asserting those rights if the need arises. The nurse advocates for the client by providing information needed so that the client can make an informed decision. The nurse needs to consider the client's religion and culture when functioning as an advocate and when providing care. The nurse would include the client's religious or cultural beliefs in discussions about treatment plans so that an informed decision can be made. The nurse also defends clients' rights in a general by speaking out against policies or actions that might endanger the client's well-being or conflict with his or her rights. Informed consent is part of the primary health care provider-client relationship; in most situations, obtaining the client's informed consent does not fall within the nursing duty. Even though the nurse assumes the responsibility for witnessing the client's signature on the consent form, the nurse does not legally assume the duty of obtaining informed consent.
A client with a diagnosis of an acute respiratory infection and sinus tachycardia is admitted to the hospital. The nurse should develop a plan of care for the client and include which intervention?
- A. Limiting oral and intravenous fluids
- B. Measuring the client's pulse once each shift
- C. Providing the client with short, frequent walks
- D. Eliminating sources of caffeine from meal trays
Correct Answer: D
Rationale: Sinus tachycardia is an elevated heart rate that can be exacerbated by stimulants such as caffeine. Eliminating sources of caffeine from meal trays helps manage the client's heart rate, which is critical in the context of an acute respiratory infection where cardiac demand may already be increased. Limiting fluids is not indicated unless specific fluid overload conditions are present, which is not mentioned. Measuring the pulse once per shift is insufficient for monitoring tachycardia, as more frequent assessments are needed. Short, frequent walks may be beneficial for respiratory function but do not directly address tachycardia management.