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The nurse is caring for a client who presents with hyperglycemia. Which of the following findings are expected?
- A. Blurred vision
- B. Increased urinary output
- C. Cool and clammy skin
- D. Tachycardia
- E. Orthostatic hypotension
Correct Answer: A, B, D
Rationale: Hyperglycemia causes blurred vision (osmotic lens changes), increased urination (osmotic diuresis), and tachycardia (dehydration response). Cool, clammy skin is typical of hypoglycemia, and orthostatic hypotension is less specific.
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The nurse is assessing a client with adrenal crisis. Which of the following findings would be consistent with a diagnosis of adrenal crisis?
- A. bradycardia
- B. hyponatremia
- C. hypertension
- D. pulse deficit
Correct Answer: B
Rationale: Adrenal crisis causes cortisol and aldosterone deficiency, leading to hyponatremia from sodium loss. Bradycardia, hypertension, and pulse deficit are not typical; tachycardia and hypotension are more common.
The nurse is caring for a client newly diagnosed with diabetes mellitus (type one). It would be essential to educate the client to
- A. check their hemoglobin A1C level every three months.
- B. rotate injection sites for insulin administration.
- C. examine their feet with a mirror daily.
- D. recognize the symptoms of hypoglycemia.
Correct Answer: A, B, C, D
Rationale: HbA1C monitors control, rotation prevents lipohypertrophy, foot checks prevent ulcers, and recognizing hypoglycemia symptoms ensures timely treatment in type 1 diabetes.
The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct?
- A. This medication may make you gain weight.
- B. It is best to take this medication in the morning with food.
- C. If you have further pain, it is okay to take naproxen.
- D. Your blood pressure may decrease while taking this medication.
- E. Do not abruptly stop taking this medication.
Correct Answer: A,B,E
Rationale: Prednisone can cause weight gain, should be taken in the morning with food to mimic cortisol rhythms and reduce gastrointestinal upset, and must not be stopped abruptly to prevent adrenal insufficiency. Naproxen should be avoided due to increased gastrointestinal bleeding risk, and prednisone typically increases, not decreases, blood pressure.
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 is assessing a client with hyperparathyroidism. Which of the following findings would support a diagnosis of hyperparathyroidism?
- A. nephrolithiasis
- B. hyperphosphatemia
- C. diarrhea
- D. halitosis
Correct Answer: A
Rationale: Hyperparathyroidism increases calcium levels, leading to kidney stones (nephrolithiasis). Phosphorus levels drop, not rise, and diarrhea and halitosis are unrelated to this condition.