Nokea
The client with type 2 DM is scheduled for cardiac rehabilitation exercises (cardiac rehab). The nurse notes that the client's blood glucose level is 300 mg/dL and that the urine is positive for ketones. How should the nurse proceed?
- A. Send the client to cardiac rehab; exercise will lower the client's glucose level.
- B. Give insulin; send the client for exercises with a 15-gram carbohydrate snack.
- C. Delay cardiac rehab; blood glucose levels will decrease too much with exercise.
- D. Cancel cardiac rehab; blood glucose levels will increase further with exercise.
Correct Answer: D
Rationale: Exercising with blood glucose levels exceeding 250 mg/dL and ketonuria increases the secretion of glucagon, growth hormone, and catecholamines, causing the liver to release more glucose.
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The nurse teaches the client with newly diagnosed diabetes mellitus about the signs and symptoms of hypoglycemia. Which of the following should the nurse stress in teaching? Select all that apply.
- A. Sleepiness
- B. Shallow
- C. Thirst
- D. Hunger
- E. Diaphoresis
- F. Confusion
Correct Answer: D,E,F
Rationale: Hypoglycemia causes hunger, diaphoresis, and confusion due to low blood glucose affecting the brain and body.
Which client statement about managing diabetes during illness indicates a need for further teaching?
- A. I should monitor my blood glucose more frequently.
- B. I may need more insulin during illness.
- C. I can stop insulin if I'm not eating.
- D. I should try to stay hydrated.
Correct Answer: C
Rationale: Stopping insulin during illness is dangerous as stress hormones can increase blood glucose, requiring continued or adjusted insulin dosing.
The client newly diagnosed with hyperthyroidism has a fever of 101.3°F (38.5°C). Which additional assessment findings should the nurse identify as those associated with thyroid storm? Select all that apply.
- A. Hypoventilation
- B. Heart rate 140 bpm
- C. Diarrhea last 4 days
- D. Periorbital edema
- E. Recent tooth extraction
Correct Answer: B,C,E
Rationale: Tachycardia, diarrhea, and recent stress (e.g., tooth extraction) are associated with thyroid storm due to excessive thyroid hormone.
At the beginning of thyroid replacement therapy after a thyroidectomy, the nurse must monitor the client closely for side effects. Which findings would the nurse expect to detect if the client is receiving more thyroid hormone replacement than required? Select all that apply.
- A. Hyperglycemia
- B. Tachycardia
- C. Insomnia
- D. Hirsutism
- E. Hypertension
Correct Answer: B,C,E
Rationale: Excess thyroid hormone can cause tachycardia, insomnia, and hypertension due to increased metabolic rate.
At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority?
- A. Blood pressure and pulse
- B. Color and temperature of skin
- C. Reflexes and muscle tone
- D. Serum electrolytes and glucose
Correct Answer: D
Rationale: Irritability in Type 1 diabetes suggests hypoglycemia or hyperglycemia, requiring priority assessment of serum glucose.