Nokea
The nurse is caring for the client with type 2 DM. Which instructions should the nurse provide to the client regarding diabetes management during stress or illness? Select all that apply.
- A. Notify the health care provider if unable to keep fluids or foods down.
- B. Test fingerstick glucose levels and urine ketones daily and keep a record.
- C. Continue to take oral hypoglycemic medications and/or insulin as prescribed.
- D. Supplement food intake with carbohydrate-containing fluids, such as juices or soups.
- E. When on an oral agent, administer insulin in addition to the oral agent during the illness.
- F. A minor illness, such as the flu, usually does not affect the blood glucose and insulin needs.
Correct Answer: A,C
Rationale: Notifying the HCP prevents dehydration, and continuing medications manages hyperglycemia during illness.
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Immediately after surgery, the nurse assesses the client for bleeding. Where is the best location to assess for bleeding?
- A. The skull
- B. The nose
- C. The ear canal
- D. The tongue
Correct Answer: B
Rationale: Trans-sphenoidal hypophysectomy is performed through the nasal cavity, so bleeding is most likely to be observed in the nose.
When the nurse reviews the client's history, which assessment finding is closely associated with the client's diagnosis?
- A. Nightly leg cramps
- B. Recurrent kidney stones
- C. Loose bowel movements
- D. Excessive energy level
Correct Answer: B
Rationale: Hyperparathyroidism causes hypercalcemia, which can lead to recurrent kidney stones.
Which signs/symptoms should the nurse expect to assess in the client diagnosed with an insulinoma?
- A. Nervousness, jitteriness, and diaphoresis.
- B. Flushed skin, dry mouth, and tented skin turgor.
- C. Polyuria, polydipsia, and polyphagia.
- D. Hypertension, tachycardia, and feeling hot.
Correct Answer: A
Rationale: An insulinoma is a pancreatic tumor causing excessive insulin secretion, leading to hypoglycemia. Symptoms include nervousness, jitteriness, and diaphoresis (Whipple’s triad). Flushed skin and dehydration suggest hyperglycemia, polyuria/polydipsia/polyphagia are diabetes symptoms, and hypertension/tachycardia are more typical of pheochromocytoma.
The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test?
- A. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours.
- B. The client will be administered an injection of antidiuretic hormone (ADH), and urine output will be measured for four (4) to six (6) hours.
- C. The client will have nothing by mouth (NPO), and vital signs and weights will be done hourly until the end of the test.
- D. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.
Correct Answer: C
Rationale: The fluid deprivation test involves NPO status with hourly vitals and weights to assess urine concentration, diagnosing DI. Other options describe incorrect procedures.
The nurse is planning to address diabetic meal planning with the client recently diagnosed with type 1 DM. Which action should the nurse take first?
- A. Encourage use of non-nutritive sweeteners that contain no calories.
- B. Emphasize the importance of keeping regular mealtimes every day.
- C. Teach the client how to count the carbohydrates in meals and snacks.
- D. Ask the client to identify favorite foods and the client's usual mealtimes.
Correct Answer: D
Rationale: Asking about favorite foods and usual mealtimes is an assessment question used in obtaining a thorough diet history; the nurse should take this action first prior to beginning teaching.