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The nurse has obtained a prescription for desmopressin to treat diabetes insipidus (DI). The nurse understands that it is essential to monitor the clients
- A. serum sodium level.
- B. serum glucose.
- C. serum magnesium level.
- D. serum calcium level.
Correct Answer: A
Rationale: Desmopressin treats diabetes insipidus by reducing water excretion, risking hyponatremia. Monitoring serum sodium is essential. Glucose, magnesium, and calcium are not primarily affected.
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The nurse is caring for a client who presents with a blood glucose level of 45 mg/dL (2.4975 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]. Which of the following findings are expected?
- A. Blurred vision
- B. Increased urinary output
- C. Cool and clammy skin
- D. Palpitations
- E. Orthostatic hypotension
- F. Paresthesias
Correct Answer: C, D, F
Rationale: Hypoglycemia causes sympathetic activation (cool, clammy skin; palpitations) and neurological symptoms (paresthesias). Blurred vision and increased urination are more typical of hyperglycemia, and orthostatic hypotension is less directly related.
The nurse is teaching a client about diabetes mellitus. Which of the following information should the nurse include?
- A. You will need yearly hemoglobin A1C lab tests.
- B. Your diet should consist mostly of simple carbohydrates.
- C. Annual visual examinations are recommended.
- D. You should take more insulin before exercising.
- E. Your liver enzymes will be monitored closely.
- F. Check your blood sugar if you start to feel shaky.
Correct Answer: A, C, F
Rationale: HbA1C monitors long-term control, ideally every 3 months, but yearly is a start. Annual eye exams detect retinopathy. Checking glucose during shakiness prevents hypoglycemia. Simple carbs raise glucose rapidly, insulin needs vary, and liver monitoring is not routine.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 4 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]
For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. Serum hemoglobin A1C
- B. 24-hour urinary cortisol levels
- C. Serum complete metabolic panel
- D. Serum clonidine suppression test
- E. Serum complete blood count
- F. Administration of a prescribed corticosteroid
- G. Referral for neurology consultation
Correct Answer: A, B, C, E
Rationale: HbA1C assesses long-term glucose control, 24-hour cortisol tests for Cushing's, CMP evaluates electrolytes and glucose, and CBC checks for infection or anemia. Clonidine suppression is for pheochromocytoma, corticosteroids are not indicated, and neurology referral is unnecessary without neurological symptoms.
The nurse is caring for a client who has diabetes mellitus. Which of the following would indicate the client is achieving the treatment goals?
- A. Fasting blood glucose 145 mg/dl (8.05 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- B. Creatinine 2.3 mg/dl (203.32 μmol/L) [Male: 0.6-1.2 mg/dL Female: 0.5-1.1 mg/dL, Male 49-93 ¼mol/L Female 22-75 ¼mol/L]
- C. Urine Specific Gravity 1.043 [1.005-1.030]
- D. Hemoglobin A1C 6.7% [ < 7%]
Correct Answer: D
Rationale: HbA1C of 6.7% indicates good long-term glucose control (target <7%). Elevated fasting glucose, creatinine, and urine specific gravity suggest poor control or complications like renal issues.
The nurse is caring for a client with Cushing's disease. Which of the following complications are associated with this condition?
- A. cataracts
- B. diabetes mellitus
- C. orthostatic hypotension
- D. osteoporosis
- E. venous thromboembolism
Correct Answer: A, B, D, E
Rationale: Cushing's excess cortisol causes cataracts, diabetes from hyperglycemia, osteoporosis from bone loss, and thromboembolism from hypercoagulability. Orthostatic hypotension is not typical.