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The nurse at a freestanding health-care clinic is caring for a 56-year-old male client who is homeless and is a type 2 diabetic controlled with insulin. Which action is an example of client advocacy?
- A. Ask the client if he has somewhere he can go and live.
- B. Arrange for someone to give him insulin at a local homeless shelter.
- C. Notify Adult Protective Services about the client's situation.
- D. Ask the HCP to take the client off insulin because he is homeless.
Correct Answer: B
Rationale: Arranging insulin administration at a shelter ensures the client’s medical needs are met, advocating for his health. Housing questions, APS notification, and stopping insulin are less supportive.
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Which sign is most suggestive that a client with type 2 diabetes is developing hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
- A. The client's serum glucose level is 650 mg/dL.
- B. The client's urinary output is 3,000 mL/24 hours.
- C. The client's skin is cool and moist.
- D. The client's urine contains acetone.
Correct Answer: A
Rationale: A serum glucose level of 650 mg/dL is characteristic of HHNS, indicating severe hyperglycemia.
The nurse is reviewing serum laboratory results for four female clients. Place an X on the client requiring the most immediate assessment.
- A. Client A: TSH 5.2 mIU/L, Free T4 0.8 ng/dL
- B. Client B: GH 23 µg/L, IGF-I 490 ng/mL
- C. Client C: Free T4 7.0 ng/dL, TSH 0.1 mIU/L
- D. Client D: Fasting glucose 140 mg/dL, Hgb A1c 6.9%
Correct Answer: C
Rationale: Client C has elevated free T4 and decreased TSH, indicating hyperthyroidism, which can lead to life-threatening thyroid storm with severe hypertension and tachycardia, requiring immediate assessment.
A clinic nurse is teaching the client newly diagnosed with hypothyroidism. Which instructions should the nurse provide about taking levothyroxine sodium? Select all that apply.
- A. Take the medication 1 hour before or 2 hours after breakfast.
- B. Call the clinic if the pulse before taking the medication is greater than 100 beats per minute.
- C. Report adverse drug effects, including weight gain, cold intolerance, and alopecia.
- D. Take this drug as prescribed; it replaces thyroid hormone thatå‚¾å‘ diminished or absent.
- E. Have frequent laboratory monitoring to be sure your levels of T3 and T4 decrease.
Correct Answer: A,B,D
Rationale: Taking levothyroxine on an empty stomach ensures absorption, notifying the clinic for tachycardia prevents overdose, and taking it as prescribed replaces deficient hormone.
To reduce or eliminate the symptoms that a client with functional hypoglycemia experiences, it is best for the nurse to recommend eating five or six small meals containing which nutrient?
- A. Simple sugars
- B. Complete proteins
- C. Complex carbohydrates
- D. Unsaturated fats
Correct Answer: C
Rationale: Complex carbohydrates provide a steady glucose release, preventing hypoglycemic episodes.
A client has a transsphenoidal hypophysectomy to remove a pituitary tumor. When the client returns to the nursing unit following surgery, the head of the bed is elevated 30 degrees. What is the primary purpose for placing the client in this position?
- A. To promote respiratory effort
- B. To reduce pressure on the sella turcica
- C. To prevent acidosis
- D. To promote oxygenation
Correct Answer: B
Rationale: Elevating the head 30 degrees reduces pressure on the sella turcica, minimizing the risk of cerebrospinal fluid leakage post-hypophysectomy.