Nokea
The nurse is caring for a client receiving a continuous infusion of regular insulin. The nurse should plan to monitor which clinical data?
- A. Hourly blood glucose
- B. Potassium
- C. BUN and creatinine
- D. Gastric pH
- E. Fasting blood glucose
Correct Answer: A, B
Rationale: Insulin lowers glucose and shifts potassium into cells, risking hypokalemia. Hourly glucose and potassium monitoring are critical to adjust therapy and prevent complications.
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The nurse has provided education to a client newly prescribed glipizide. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I will need to take this medication 30 minutes before a meal.
- B. I can expect to lose weight while taking this medication.
- C. I should not take this medication if I had a procedure involving contrast dye.
- D. This medication may cause me to develop vitamin B12 deficiency.
Correct Answer: A
Rationale: Glipizide, a sulfonylurea, should be taken 30 minutes before meals to enhance insulin secretion during eating. It may cause weight gain, not loss, and is not affected by contrast dye or linked to B12 deficiency.
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 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 following scenario applies to the next 1 items
The emergency department (ED) nurse cares for a 49-year-old male
Item 1 of 1
Nurses' Notes
0914 - Client presents to the ED with his wife reporting headaches, palpitations, sweating, and an occasional tremor in his upper extremities. The client states that these are 'episodes' and usually occur after the client engages in strenuous activity or is under stress. The onset of these symptoms was months ago, and the client could not identify a concrete time frame. The client says he has increased his alcohol consumption from two standard glasses of wine daily to three because of the 'stress at work.' He often wakes up with an occasional headache. He says that the episodes have been occurring more often and that the headaches are frustrating because they do not abate with over-the-counter medications such as acetaminophen. He states that he doesn't have any other symptoms, except he has been drinking more water lately, but attributes that to his work outside setting up a garden. He reports a weight loss of 2 kilograms (4.4 pounds) over the past month. His current body mass index is 23. His medical history includes iron deficiency anemia, herpes simplex virus, and irritable bowel syndrome. His medications include docusate, valacyclovir, and iron sucrose. He reports that his mother and father had a stroke because of high blood pressure, which makes him quite concerned. On assessment, the client is alert and fully oriented. Affect is cooperative. The peripheral pulses are +2. Lung sounds are diminished bilaterally. Bowel sounds were present in all four quadrants. He says he has a headache but cannot provide a numerical rating score stating 'it just hurts.' Vital signs: T 97.5° F (36.4° C), P 110, RR 18, BP 161/80, pulse oximetry reading 96% on room air.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress
- A. Obtain an order for a hemoglobin A1C, Obtain an order for a 24-hour urine collection, Request a prescription for a benzodiazepine, Request a prescription of an antihypertensive.
- B. peripheral pulses, mental status, capillary blood, glucose blood pressure.
- C. alcohol withdrawal syndrome, essential hypertension, pheochromocytoma, diabetes mellitus, type II
Correct Answer: C, A, D, B
Rationale: Pheochromocytoma causes headaches, palpitations, and hypertension from catecholamine excess. Order a 24-hour urine collection for catecholamines, request antihypertensives, and monitor BP and mental status for progress.
The nurse is assessing a client with pheochromocytoma. Which of the following would be an expected finding?
- A. hyperglycemia
- B. hypertension
- C. ataxia
- D. oliguria
- E. headache
Correct Answer: A, B, E
Rationale: Pheochromocytoma releases catecholamines, causing hyperglycemia, hypertension, and headaches. Ataxia and oliguria are not typical findings.