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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.
You may also like to solve these questions
The nurse is caring for a client who presents with hyperglycemia. Which of the following findings are expected?
- A. Blurred vision
- B. Increased urinary output
- C. Cool and clammy skin
- D. Tachycardia
- E. Orthostatic hypotension
Correct Answer: A, B, D
Rationale: Hyperglycemia causes blurred vision (osmotic lens changes), increased urination (osmotic diuresis), and tachycardia (dehydration response). Cool, clammy skin is typical of hypoglycemia, and orthostatic hypotension is less specific.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 3 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
Complete the following sentence by choosing from the list of options. The client is at highest risk for developing.......
- A. dysrhythmias.
- B. fluid volume overload
- C. adrenal crisis
- D. metabolic syndrome.
Correct Answer: D
Rationale: Elevated glucose, hypertension, BMI of 32, and weight gain suggest metabolic syndrome, a cluster of conditions increasing cardiovascular and diabetes risk. Dysrhythmias, fluid overload, and adrenal crisis are less directly tied to these findings.
The nurse is assessing a client with diabetes mellitus type 2. Which of the following findings would be consistent with a diagnosis of diabetes mellitus type 2?
- A. Fasting blood glucose level 110 mg/dL (6.1 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- B. Hemoglobin A1c (HbA1c) level 7.5% [ < 5.7%]
- C. Elevated Serum Insulin Levels
- D. Presence of ketones in the urine
Correct Answer: B
Rationale: HbA1c of 7.5% indicates poor long-term glucose control, consistent with type 2 diabetes (diagnosis: ≥6.5%). Fasting glucose at 110 mg/dL is borderline, elevated insulin reflects resistance, and ketones are more typical of type 1 or DKA.
The nurse in the clinic is caring for a 32-year-old female client.
Item 6 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
Orders
1714:
Arrange for a follow-up appointment in 3 days
Lab orders: serum complete blood count, complete metabolic panel, hemoglobin A1C
24-hour urinary cortisol excretion
Progress Notes
Follow-up appointment 3 days later
1544: Client presents for a 3-day follow-up. Laboratory findings confirm Cushing's disease with the 24-hour urine cortisol test at 125 mcg/24 hour [10 to 100 mcg/24]. CMP showed hyperglycemia, hypernatremia, and hypokalemia. Will refer to endocrinology for further evaluation and management. Will prescribe potassium supplementation.
For each of the statements made by the client, click to specify whether the statement indicates an understanding or requires follow-up of the discharge teaching provided on Cushing's disease.
- A. I should start using a salt substitute to season my foods.
- B. Exercise such as swimming is appropriate.
- C. I should start eating snacks high in sodium and potassium.
- D. I will limit my caffeine consumption.
- E. This condition requires me to avoid getting the seasonal influenza vaccine.
- F. I should notify my doctor if I start to develop constipation and muscle weakness.
Correct Answer: A, C, E
Rationale: Salt substitutes reduce sodium, appropriate for Cushing's-related hypertension. High sodium snacks are incorrect due to fluid retention risks. Limiting caffeine is good, and avoiding vaccines is wrong—immunizations are crucial. Notifying the doctor about weakness is correct.
The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for
- A. enalapril
- B. regular insulin
- C. levothyroxine
- D. dexamethasone
Correct Answer: D
Rationale: Thyroid storm requires blocking excess thyroid hormone effects. Dexamethasone reduces hormone release and inflammation. Enalapril is for hypertension, insulin for glucose, and levothyroxine worsens the condition.