Nokea
The nurse is assessing a client with diabetic ketoacidosis (DKA). Which of the following would be an expected finding?
- A. Thready pulse
- B. Jugular venous distention (JVD)
- C. Coarse tremors
- D. Tachycardia
- E. Orthostatic hypotension
Correct Answer: A, D, E
Rationale: DKA causes dehydration, leading to thready pulse, tachycardia, and orthostatic hypotension. JVD suggests fluid overload, and coarse tremors are not typical.
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The nurse is caring for a client who recently had a dosage increase of prescribed levothyroxine. Which of the assessments following the increase is a priority?
- A. Weight
- B. Heart rate
- C. Activity status
- D. Oral temperature
Correct Answer: B
Rationale: Levothyroxine increases metabolism, and a dosage increase can cause hyperthyroidism symptoms, including tachycardia. Monitoring heart rate is a priority to detect adverse effects like arrhythmias. Weight, activity status, and temperature are relevant but less urgent.
The following scenario applies to the next 1 items.
The nurse is caring for a client in the emergency department (ED) with an altered level of consciousness
Item 1 of 1
History and Physical
A 53-year-old male presented to the emergency department (ED) with his wife because the client had become quite tired over the past several days. Today, he was difficult to arouse and spoke incoherently. The client responded to his name during the assessment but did not answer any other questions. Peripheral pulses were thready. Obvious tenting was noted in the skin, which was warm and quite dry. No facial drooping was observed, and when asked to hold out his arms, he could not perform the task. In fact, he did not have many purposeful movements during the exam. The client has a medical history of gout, bipolar disorder, and hypothyroidism, for which he takes levothyroxine, allopurinol, and quetiapine. She reports that he has been taking his medications as prescribed. However, she noted he was recently placed on Prednisone 20 mg PO BID for a gout flare. He self-discontinued the drug after taking it for two weeks and feeling better, and he did not taper as directed.
Vital Signs
Temperature 98.0° F (37° C)
Pulse 121/minute
Respirations 16/minute
Blood Pressure 90/60 mm Hg
Pulse oximetry 95% on room air
Diagnostics
12-lead electrocardiogram: sinus tachycardia with peaked T waves
Complete the sentence below by dragging one (1) condition and one (1) assessment finding. The client is at highest risk for............. related to the client's...........
- A. myxedema coma
- B. catatonia
- C. adrenal crisis
- D. cessation of prednisone
- E. lack of purposeful movement
- F. history of hypothyroidism
Correct Answer: C, D
Rationale: Abrupt cessation of prednisone in a client on chronic steroids can precipitate adrenal crisis due to suppressed adrenal function. Altered consciousness, thready pulses, and dehydration support this risk.
The nurse is teaching a client prescribed prednisolone. Which of the following information should the nurse include?
- A. Take this medication in the morning with food.
- B. The best time to take this medication is later in the afternoon without food.
- C. This medication before bed with a light snack.
- D. You can take this medication anytime, as long as you take it on an empty stomach.
Correct Answer: A
Rationale: Prednisolone should be taken in the morning with food to align with cortisol rhythms and minimize gastrointestinal upset. Afternoon, bedtime, or empty-stomach dosing increases side effects or reduces efficacy.
The nurse is teaching a client with diabetes mellitus (type two) newly prescribed rapid-acting insulin. Which of the following information should the nurse include?
- A. Once you open your vial of insulin, discard it 25 days after opening it.
- B. Inject yourself with this insulin 20-30 minutes before meals.
- C. You can inject yourself with this insulin while you are actively eating.
- D. This insulin is administered right before you go to bed to minimize overnight blood sugar spikes.
Correct Answer: C
Rationale: Rapid-acting insulin, like lispro, can be injected just before or during meals to match carbohydrate intake. Vials are typically good for 28 days, not 25, and bedtime dosing is for long-acting insulin.
This nurse is caring for a client who is receiving prescribed sitagliptin. Which assessment findings indicate the client is experiencing a severe adverse effect?
- A. Nasal stuffiness
- B. Abdominal pain
- C. Headache
- D. Occasional dry cough
Correct Answer: B
Rationale: Abdominal pain may indicate pancreatitis, a rare but severe sitagliptin adverse effect, requiring immediate attention. Nasal stuffiness, headache, and dry cough are less severe.