Nokea
The nurse is caring for a client with type 1 diabetes mellitus who develops hyperglycemia between 5:00 and 6:00 AM as a result of the nighttime release of growth hormone. The nurse should recognize that this condition is consistent with
- A. dawn phenomenon.
- B. Somogyi effect.
- C. hyperosmolar hyperglycemic syndrome (HHS).
- D. diabetic ketoacidosis (DKA).
Correct Answer: A
Rationale: Dawn phenomenon is early morning hyperglycemia from growth hormone and cortisol release, common in type 1 diabetes. Somogyi involves rebound from hypoglycemia, and HHS and DKA are acute complications.
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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 following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 2 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]
The nurse recognizes which of the following conditions may cause a client to manifest hyperglycemia?
- A. diabetes insipidus
- B. adrenal insufficiency
- C. pheochromocytoma
- D. hyperpituitarism
- E. pancreatitis
Correct Answer: C, D, E
Rationale: Pheochromocytoma releases catecholamines, raising glucose. Hyperpituitarism increases growth hormone, impairing glucose metabolism. Pancreatitis damages insulin-producing cells, causing hyperglycemia. Diabetes insipidus and adrenal insufficiency do not typically elevate glucose.
The nurse is caring for a client who has nephrogenic diabetes insipidus. Which of the following medications should the nurse expect to be prescribed for the client?
- A. prednisone
- B. hydrochlorothiazide
- C. verapamil
- D. lithium
Correct Answer: B
Rationale: Nephrogenic diabetes insipidus reduces kidney response to ADH. Hydrochlorothiazide paradoxically reduces urine output by increasing sodium excretion, concentrating urine. Prednisone, verapamil, and lithium are unrelated or worsen DI.
The nurse is educating a diabetic client regarding foot care. Which of the following statements by the client indicates a correct understanding of the nurse's instructions?
- A. I need to check my feet daily for sores, blisters, dry skin, and cuts.
- B. I need to wash my feet daily and keep them dry.
- C. If I get sores or blisters on my feet, I should not pop them.
- D. I need to apply cream to my heels and between my toes daily.
- E. I should wear tight compression socks on both feet.
Correct Answer: A, B, C
Rationale: Daily checks, washing, and keeping feet dry prevent complications. Not popping sores avoids infection. Cream between toes risks fungal growth, and tight socks impair circulation.
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.