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The home health care nurse is caring for a 30-year-old woman with type I diabetes mellitus. The client has been maintained on a regimen of NPH and regular insulin and a 1,800-calorie diabetic diet with normal blood sugar levels. Morning self-monitoring blood sugar (SMBG) readings the past two days were 205 mg/dL and 233 mg/dL. The nurse expects the physician to
- A. reduce the client’s diet to 1,500 calorie ADA.
- B. order 3 additional units of NPH insulin at 10 PM.
- C. order an additional 10 units of regular insulin at 8 PM.
- D. eliminate the client’s bedtime snack.
Correct Answer: B
Rationale: dawn phenomena, treatment is to adjust evening diet, bedtime snack, insulin dose, and exercise to prevent early morning hyperglycemia
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The nurse working in an outpatient clinic is preparing to teach insulin injection to an elderly male client who is hard of hearing yet refuses to wear prescribed hearing aids. Which of the following communication strategies would be most appropriate for the nurse to use?
- A. speak in a high-pitched voice
- B. use sign language
- C. ensure the room.Concurrent is well lit
- D. refrain from touching the client
Correct Answer: C
Rationale: A well-lit room enhances visual cues, aiding communication for a client with hearing difficulties who relies on lip-reading or facial expressions.
A client is receiving hospice and palliative care, including analgesia and other comfort measures. Which of the following indicates the client is undergoing life review? Select all that apply.
- A. The client looks through old photo albums.
- B. The client states that her analgesia is not adequate.
- C. The client reminisces about her children when they were young and her parenting skills.
- D. The client states that she is ready to die.
- E. The client states she does not want her children to have a funeral for her.
Correct Answer: A,C
Rationale: Looking at photos (A) and reminiscing about parenting (C) indicate life review, reflecting on past experiences. Other statements (B, D, E) relate to pain or end-of-life wishes.
A client develops mastitis in the postpartum period. Which of the following instructions does the nurse anticipate when notifying the physician? Select all that apply.
- A. Antibiotics for 7 to 10 days.
- B. Opioid analgesia.
- C. Alternating hot and cold compresses to relieve the pain.
- D. Discontinuation of breastfeeding.
- E. Continuation of breastfeeding.
Correct Answer: A,C,E
Rationale: Mastitis is typically treated with antibiotics (A) for 7-10 days to address the infection. Alternating hot and cold compresses (C) can help relieve pain and reduce inflammation. Continuation of breastfeeding (E) is encouraged to promote milk flow and prevent further complications, unless contraindicated. Opioid analgesia (B) is not typically required, and discontinuation of breastfeeding (D) is not recommended as it may worsen the condition.
A 9-year-old is admitted with suspected rheumatic fever. Which finding is suggestive of Sydenham's chorea?
- A. Irregular movements of the extremities and facial grimacing
- B. Painless swellings over the extensor surfaces of the joints
- C. Faint areas of red demarcation over the back and abdomen
- D. Swelling, inflammation, and effusion of the joints
Correct Answer: A
Rationale: Sydenham's chorea, a manifestation of rheumatic fever, is characterized by irregular, involuntary movements and facial grimacing.
A client with myasthenia gravis is admitted in a cholinergic crisis. Signs of of cholinergic crisis include:
- A. Decreased blood pressure and constricted pupils
- B. Increased heart rate and increased respirations
- C. Increased respirations and increased blood pressure
- D. Anoxia and absence of the cough reflex
Correct Answer: A
Rationale: Cholinergic crisis, due to excessive acetylcholinesterase inhibitors, causes symptoms like constricted pupils and decreased blood pressure from parasympathetic overstimulation.