Nokea
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.
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The following scenario applies to the next 1 items
The emergency department (ED) nurse is caring for a 66-year-old male client
Item 1 of 1
History and Physical
2000: 66-year male arrives at the emergency department (ED) following a recommendation by his primary healthcare provider (PHCP). The client called his PHCP in the morning, reporting a headache, feeling unwell, fatigue, and thirst. He could not check his blood glucose because he reports being out of testing supplies for two weeks. He also reports being unable to take his prescribed antihypertensive and antidiabetic medications for one week because he lost his job. On exam, the client reports feeling fatigued and thirsty. He is alert and completely oriented. His physical exam was within normal limits except for a thready pulse with a rate of 119/minute.
The client has a medical history of type II diabetes mellitus, congestive heart failure (CHF), hypertension, and hyperlipidemia. He is prescribed atorvastatin, metformin, and lisinopril.
Vital Signs
Oral Temperature 98o F (36.7o C)
Pulse 119/minute
Respirations 19/minute
Blood pressure 98/52 mm Hg
Oxygen saturation 96% on room air
Physician Orders
Obtain intravenous (IV) access
Five units of regular insulin via intravenous push (IVP)
Infuse two liters of 0.9% saline over one hour
Obtain capillary blood glucose (CBG) every two hours
Potassium chloride 20 mEq by mouth x 1 dose
Implement seizure precautions
The nurse reviews laboratory work ordered by the primary healthcare provider (PHCP). The nurse obtains physician orders for this client with hyperosmolar hyperglycemic state (HHS) . The nurse is preparing to implement the physician's orders. Which order should the nurse clarify with the physician?
- A. Infuse two liters of 0.9% saline over one hour
- B. Obtain capillary blood glucose every two hours
- C. Potassium chloride 20 mEq by mouth
- D. Implement seizure precautions
Correct Answer: A
Rationale: Infusing 2 liters of saline in one hour is too rapid for HHS, risking fluid overload. Slower infusion (e.g., 1 liter over 2-4 hours) is safer. Other orders align with HHS management.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 1 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]
Select the client findings that require follow-up.
- A. Capillary blood glucose
- B. Peripheral pulse findings
- C. Blood pressure
- D. Not taking birth control
Correct Answer: A, C, F, G
Rationale: Elevated glucose (254 mg/dL) suggests hyperglycemia, needing investigation. BP (145/93) indicates hypertension, requiring monitoring. Edema and BMI of 32 signal potential endocrine or cardiac issues. Peripheral pulses are normal and birth control is unrelated.
The nurse is preparing to administer metformin to a client with diabetes mellitus (type two). Which of the following laboratory test results should the nurse monitor during the therapy?
- A. white blood cell (WBC) count
- B. vitamin B12 level
- C. serum uric acid level
- D. thyroid-stimulating hormone (TSH) level
Correct Answer: B
Rationale: Metformin can cause vitamin B12 deficiency over time, requiring monitoring. WBC, uric acid, and TSH are not primarily affected by metformin.
The nurse is caring for a client scheduled for a computed tomography (CT) scan with contrast. The nurse recognizes which medication should be held after the procedure?
- A. labetalol
- B. metformin
- C. levodopa
- D. ondansetron
Correct Answer: B
Rationale: Metformin should be held after a CT scan with contrast due to the risk of lactic acidosis if contrast-induced nephropathy occurs. Labetalol, levodopa, and ondansetron are not affected by contrast.
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.