Nokea
The nurse is caring for a client diagnosed with hyperparathyroidism. Which laboratory data would support this diagnosis?
- A. Potassium 4.1 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L]
- B. Phosphorus 4.9 mEq/L (mmol/L) [2-4.5 mEq/L, 0.81-1.58 mmol/L]
- C. Calcium 11.2 mg/dL (2.8 mmol/L) [9-10.5 mg/dL, 2.12-2.52 mmol/L]
- D. Sodium 132 mEq/L (mmol/L) [135-145 mEq/L, mmol/L]
Correct Answer: C
Rationale: Hyperparathyroidism increases PTH, raising blood calcium (11.2 mg/dL is elevated) and often lowering phosphorus. Potassium and sodium are not directly affected.
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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.
The nurse is caring for a client with a prescribed subcutaneous (SQ) regular insulin sliding scale. The client's current blood glucose level is 360 mg/dL (19.98 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]. Which of the following actions should the nurse take? See the exhibit.
- A. Notify the primary health care provider (PHCP).
- B. Administer 8 units of regular insulin.
- C. Administer 10 units of regular insulin.
- D. Recheck the client's blood glucose in one hour.
- E. Administer the insulin intravenous (IV) push.
Correct Answer: A,B
Rationale: A blood glucose of 360 mg/dL is significantly elevated, requiring insulin per the sliding scale (e.g., 8 units for 351–400 mg/dL, depending on the exhibit) and PHCP notification for further management. IV push is inappropriate for SQ scales, and rechecking in one hour follows administration.
The nurse is evaluating the treatment plan for a client with type II diabetes mellitus. Select the findings in the nurses' note that indicate that the client is not meeting the treatment goals
- A. The client presents for a routine follow-up after being diagnosed with diabetes mellitus type II.
- B. The most recent hemoglobin A1C was 7.6%.
- C. A weight gain of three kilograms was noted.
- D. The client reports a painless ulcer on the right anterior ankle.
- E. The client stated he stopped walking barefoot.
- F. The client requested a referral for a diabetic cooking class.
Correct Answer: B, C, D
Rationale: HbA1C of 7.6% exceeds the target (<7%), indicating poor control. Weight gain and a painless ulcer suggest complications like poor circulation or neuropathy. Stopping barefoot walking and requesting classes are positive steps.
The following scenario applies to the next 1 items
The home health nurse visits a client with chronic diabetes insipidus
Item 1 of 1
Nurses’ Note
1415 – Home health visit completed because the client was admitted to the hospital twice in the past six weeks for treatment nonadherence related to diabetes insipidus. Extensive teaching provided and reviewed education on prescribed desmopressin intranasal, maintenance of fluids, daily weight, intake and output, and when to seek emergency care.
Which client statements would indicate a correct understanding of the teaching?
- A. I should limit the amount of fluids that I drink after 5:00 PM.
- B. I will need to weigh myself at the same time every day.
- C. I should put both doses of the desmopressin in one nostril.
- D. I need to keep a log of my fluid intake and urine output.
- E. I may need an additional dose if I keep urinating a lot.
- F. If I develop confusion with this medication, I should call 911.
Correct Answer: B, D, F
Rationale: Daily weighing and logging intake/output monitor diabetes insipidus. Confusion may signal hyponatremia, needing emergency care. Fluid limits are incorrect, desmopressin dosing is per nostril, and extra doses require a provider's order.
The following scenario applies to the next 1 items
The nurse in the intensive care unit (ICU) is caring for a 38-year-old client being treated for diabetic ketoacidosis (DKA).
Item 1 of 1
Nurses' Notes
0700 - Handoff report received. On assessment, the client’s breathing appears regular without any distress, and clear lung sounds are noted in all lung fields. Skin is warm to the touch and pink in tone; pulses 2+ and regular. Capillary refill is 3 seconds. Client is alert and oriented to person, place, and time. Two peripheral venous access devices (VAD) were noted in the right and left antecubital spaces. The right VAD had 0.9% saline infusing at 100 mL/hr, and the left had regular insulin infusing at 4 units/hr.
Physician Orders
• Continuous infusion of regular insulin per DKA protocol
• 0.9% saline at 100 mL/hr
• Basic metabolic panel (BMP) every 3 hours
• Obtain capillary blood glucose hourly
• Daily complete blood counts (CBC)
The nurse reviews the physician's orders and plans care. Complete the sentences below from the list of options. The nurse understands that the.....needs to be monitored due to the client's risk for..............
- A. complete blood count
- B. basic metabolic panel
- C. capillary blood glucose
- D. hyperglycemia
- E. hypokalemia
- F. hemoconcentration
Correct Answer: B, E
Rationale: In DKA, insulin shifts potassium into cells, risking hypokalemia. The basic metabolic panel monitors potassium and electrolytes, critical for safe treatment and avoiding arrhythmias.