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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.
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The nurse is interviewing a client taking prescribed methimazole for hyperthyroidism. Which assessment finding requires notification to the physician?
- A. body mass index (BMI) 23
- B. sore throat
- C. pulse (P) 84
- D. skin rash
Correct Answer: B
Rationale: Sore throat may indicate agranulocytosis, a rare but serious methimazole side effect, requiring immediate physician notification. BMI 23, pulse 84, and skin rash are less urgent unless severe.
The nurse is caring for a client eight hours postoperative following a total thyroidectomy. Which of the following assessment findings indicate that the client is developing a complication?
- A. Moderate amount of dried sanguineous drainage on the dressing
- B. Oral temperature of 99.2°F (37.3°C)
- C. Apical pulse of 56
- D. The client reports a sore throat when speaking
Correct Answer: A
Rationale: Excessive drainage post-thyroidectomy may indicate hemorrhage, a serious complication. A slightly elevated temperature, mild bradycardia, and sore throat are expected or less concerning in the immediate postoperative period.
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 preceptor observes a newly hired nurse care for a client with a myxedema coma. It would require follow up by the nurse preceptor if the newly hired nurse is observed
- A. applying a cooling blanket to the client.
- B. requesting a prescription for hydrocortisone.
- C. removing the water pitcher from the bedside.
- D. placing an oral endotracheal tube at the bedside for potential use.
Correct Answer: A
Rationale: Myxedema coma is a severe hypothyroid state with hypothermia. A cooling blanket worsens this; a warming blanket is needed. Hydrocortisone addresses adrenal insufficiency, removing water prevents dilutional hyponatremia, and an endotracheal tube is prudent for potential respiratory support.
The nurse is educating a group of students on the effects of corticosteroids. It would be appropriate for the nurse to identify the following adverse effects associated with corticosteroids.
- A. Mood lability
- B. Immunosuppression
- C. Hypoglycemia
- D. Hyperkalemia
- E. Weight gain
Correct Answer: A, B, E
Rationale: Corticosteroids cause mood changes, suppress immunity, and promote weight gain via fluid retention and fat redistribution. They cause hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia.