Nokea
The nurse assesses clients for the risk of developing hyperosmolar hyperglycemic syndrome. Which of the following clients should the nurse consider to be at greatest risk?
- A. 63-year-old with diabetes mellitus (type two) who works outdoors and recently had an increased dosage of metformin.
- B. 55-year-old with diabetes mellitus (type one) who was recently hospitalized for pneumonia and occasionally forgets to take their long-acting insulin.
- C. 15-year-old with diabetes mellitus (type one) who has a hemoglobin A1C of 7.6% [ < 7%] and has gained 4 lbs (1.8 kg) in the past month.
- D. 45-year-old who was recently diagnosed with diabetes mellitus (type two) and was prescribed glipizide in addition to metformin.
Correct Answer: A
Rationale: HHS is common in type 2 diabetes, especially in older adults. Outdoor work risks dehydration, and increased metformin may not control severe hyperglycemia, heightening HHS risk.
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The nurse is reviewing a client's list of medications who has cystic fibrosis. The nurse anticipates a prescription for which medication?
- A. Pancrelipase
- B. Aspirin
- C. Lactulose
- D. Multivitamin
- E. Clopidogrel
Correct Answer: A,D
Rationale: Cystic fibrosis impairs pancreatic function, requiring pancrelipase for enzyme replacement and multivitamins to address fat-soluble vitamin deficiencies. Aspirin, lactulose, and clopidogrel are not typically indicated.
The nurse has provided medication instruction to a client who has been prescribed metformin. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching?
- A. This medication may cause me to have bloating or loose stools.
- B. I will need to take my blood glucose prior to taking this medication.
- C. If I eat fewer carbohydrates in a day, I should skip a dose.
- D. The goal of this medication is to increase my hemoglobin A1C.
Correct Answer: A
Rationale: Metformin commonly causes gastrointestinal side effects like bloating or loose stools. Blood glucose checks are not required before dosing, skipping doses is inappropriate, and metformin aims to lower, not increase, HbA1c.
The nurse cares for a 38-year-old female client recently diagnosed with Graves' disease. The client presents with a visibly enlarged thyroid gland, heat intolerance, excessive sweating, and unintentional weight loss. What additional signs or symptoms may be present in this client?
- A. Increased heart rate and palpitations
- B. Diarrhea and frequent bowel movements
- C. Tremors, particularly in the hands and fingers
- D. Eye changes such as exophthalmos
- E. Intolerance to cold temperatures
Correct Answer: A, B, C, D
Rationale: Graves' disease, a hyperthyroid condition, causes tachycardia, palpitations, diarrhea, tremors, and exophthalmos due to increased metabolism and autoimmunity. Cold intolerance is a hypothyroid symptom.
The following scenario applies to the next 1 items
The nurse in the physician's office is providing education to a client with diabetes mellitus (type one)
Item 1 of 1
Nurses' Note
1655: Client reports to the clinic with an interest in a prescription for an insulin pump. The client reports that he has been inconvenienced by injecting himself with insulin over the past year, considering he is traveling more for work. The client indicates that he heard about insulin pumps and thinks it would be a good fit for his lifestyle.
Orders
1730:
Continuous subcutaneous insulin infusion (insulin pump)
The nurse evaluates the client's understanding following a teaching session regarding the newly prescribed continuous subcutaneous insulin infusion (insulin pump). Click to specify if the client statement indicates effective understanding or requires follow-up
- A. I will load my aspart insulin into my pump.
- B. I will change the infusion set every 5-7 days.
- C. By having this pump, I will be able to check my glucose level less often.
- D. I will keep an extra vial of insulin in my car.
- E. If I remove my pump, it could cause me to develop hypoglycemia.
- F. Using this pump will lower my risk for diabetic ketoacidosis.
- G. I should roll my vial of insulin prior to putting it into the pump.
Correct Answer: A
Rationale: Aspart is fast-acting, ideal for pumps, and rotating sites prevents complications. Pumps don't check glucose, car storage risks temperature damage, removal risks hyperglycemia, and DKA risk remains. Rolling insulin is unnecessary for pumps.
The nurse is caring for a client receiving prescribed dexamethasone. Which of the following adverse reactions may occur?
- A. Infection
- B. Hypotension
- C. Peripheral edema
- D. Hypoglycemia
- E. Weight loss
- F. Insomnia
Correct Answer: A,C,F
Rationale: Dexamethasone, a corticosteroid, increases infection risk, causes fluid retention (peripheral edema), and insomnia. Hypotension, hypoglycemia, and weight loss are not typical; hypertension, hyperglycemia, and weight gain are more common.