Nokea
The healthcare provider is caring for a client with Cushing's syndrome. Which of the following nursing interventions is appropriate?
- A. Monitor blood glucose levels
- B. Restrict fluid intake
- C. Administer potassium supplements
- D. Encourage a high-protein diet
Correct Answer: A
Rationale: Clients with Cushing's syndrome are at risk for hyperglycemia due to the effects of cortisol on glucose metabolism. Monitoring blood glucose levels is crucial to detect and manage hyperglycemia promptly. Restricting fluid intake (choice B) is not necessary unless specifically indicated for another condition, as clients with Cushing's syndrome are prone to fluid imbalances. Administering potassium supplements (choice C) is not appropriate as clients with Cushing's syndrome often have elevated potassium levels due to the effects of cortisol. Encouraging a high-protein diet (choice D) is not recommended as clients with Cushing's syndrome should focus on a balanced diet to manage their condition effectively.
You may also like to solve these questions
A nurse manager is reviewing the nurse's documentation on the unit. Which of the following best describes the importance of this review?
- A. The nurse manager's review of documentation is crucial to ensure that it meets legal and ethical standards and accurately reflects the care provided to patients.
- B. The nurse manager's review of documentation is important to ensure that it is thorough, accurate, and reflects the nurse's accountability for patient care.
- C. The nurse manager's review of documentation is necessary to ensure that it is consistent with the unit's policies and procedures and that it accurately reflects the care provided.
- D. The nurse manager's review of documentation is essential to ensure that it meets regulatory requirements and that it supports the delivery of safe and effective patient care.
Correct Answer: D
Rationale: The nurse manager's review of documentation is a critical aspect of maintaining quality patient care. Choice D is the correct answer as it highlights the importance of ensuring that documentation meets regulatory requirements, supporting the delivery of safe and effective patient care. Regulatory requirements are established to ensure that healthcare facilities function within established guidelines and standards, promoting patient safety and quality of care. Choices A, B, and C, although important aspects of documentation review, do not fully encapsulate the significant role of regulatory compliance in ensuring the overall quality and safety of patient care.
A client with a nasogastric tube requires irrigation once every shift. The client's serum electrolyte results show a potassium level of 4.5 mEq/L and a sodium level of 132 mEq/L. Based on these findings, which solution should the nurse use for nasogastric tube irrigation?
- A. Tap water
- B. Sterile water
- C. Sodium chloride
- D. Normal saline
Correct Answer: C
Rationale: The correct solution for nasogastric tube irrigation in this scenario is sodium chloride. The client's low sodium level of 132 mEq/L indicates the need to avoid further imbalance, making sodium chloride the most appropriate choice. Using tap water, which lacks electrolytes, or sterile water could potentially exacerbate the electrolyte imbalance. Normal saline, while similar to sodium chloride, may not be the best choice as it contains a higher concentration of sodium, which could further elevate the client's already borderline sodium level.
A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicates an inadequate understanding of the peak action of NPH insulin and exercise?
- A. The best time for me to exercise is every afternoon.
- B. The best time for me to exercise is right after I eat.
- C. The best time for me to exercise is after breakfast.
- D. The best time for me to exercise is after my morning snack.
Correct Answer: A
Rationale: Exercising in the afternoon may coincide with the peak action of NPH insulin, increasing the risk of hypoglycemia. The peak action of NPH insulin typically occurs 4-12 hours after administration, so exercising during this time can further lower blood sugar levels. Choices B, C, and D are better options as they suggest exercising at times that are less likely to overlap with the peak insulin action, reducing the risk of hypoglycemia.
A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which 'related-to' phrase should the nurse add?
- A. Related to bone demineralization resulting in pathologic fractures
- B. Related to exhaustion secondary to an accelerated metabolic rate
- C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
- D. Related to tetany secondary to a decreased serum calcium level
Correct Answer: A
Rationale: The correct answer is A: 'Related to bone demineralization resulting in pathologic fractures.' In chronic hyperparathyroidism, bone demineralization occurs due to the excessive release of parathyroid hormone, leading to increased calcium resorption from bones. This process weakens the bones, making the client prone to pathologic fractures. Choices B, C, and D are incorrect because they do not directly relate to the increased risk of injury associated with chronic hyperparathyroidism. Exhaustion, edema, dry skin, and tetany are not the primary risks for injury in this client population.
What is the nurse's responsibility when dealing with an impaired colleague?
- A. The nurse should report the colleague to a supervisor and follow the institution's policy for addressing impaired practice.
- B. The nurse should confront the colleague directly and offer support to seek help for the impairment.
- C. Nonmaleficence
- D. The nurse should ignore the colleague's behavior and focus on their own responsibilities.
Correct Answer: A
Rationale: When a nurse encounters an impaired colleague, the appropriate action is to report the behavior to a supervisor and follow the institution's policy for addressing impaired practice. This ensures patient safety and upholds professional standards. Choice B is incorrect because confronting the colleague directly may not be appropriate or effective in addressing the issue, and the colleague may need more structured assistance. Choice C is a principle of ethical practice but does not directly address the specific situation of dealing with an impaired colleague. Choice D is incorrect because ignoring the colleague's behavior could potentially compromise patient safety and is not in line with professional responsibility.