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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The nurse is teaching a community class to people with type 2 diabetes mellitus. Which explanation explains the development of type 2 diabetes?
- A. The islet cells in the pancreas stop producing insulin.
- B. The client eats too many foods high in sugar.
- C. The pituitary gland does not produce vasopressin.
- D. The cells become resistant to the circulating insulin.
Correct Answer: D
Rationale: Type 2 diabetes develops due to insulin resistance, where cells fail to respond to insulin. Islet cell failure is type 1, sugar intake is a risk, and vasopressin is unrelated.
The client diagnosed with Cushing's syndrome is admitted with fluid volume overload. The client weighed 190 lb on admission and 179 lb after treatment. The nurse estimates that the amount of fluid the client lost was how many milliliters?
- A. 3000 mL
- B. 4000 mL
- C. 5000 mL
- D. 6000 mL
Correct Answer: C
Rationale: One liter of fluid (1000 mL) weighs approximately 2.2 lb. An 11-lb weight loss equals 5000 mL (11 lb / 2.2 lb = 5 L × 1000 mL per L = 5000 mL).
The client is ready for discharge following an adrenalectomy. Which statement that the client makes indicates the best understanding of the client's condition?
- A. I will continue on a low-sodium, low-potassium diet.'
- B. My husband has arranged for a marriage counselor because of our fights.'
- C. I will stay out of the sun so I will not turn splotchy brown.'
- D. I will take all of those pills every day.'
Correct Answer: D
Rationale: Lifelong steroid replacement is required post-adrenalectomy, and taking prescribed pills daily shows understanding. A high-sodium, low-potassium diet is needed, and photosensitivity is not an issue.
The client is admitted to the medical department with a diagnosis of rule-out (R/O) acute pancreatitis. Which laboratory values should the nurse monitor to confirm this diagnosis?
- A. Creatinine and (BUN).
- B. Troponin and (CK-MB).
- C. Serum amylase and lipase.
- D. Serum bilirubin and calcium.
Correct Answer: C
Rationale: Elevated amylase and lipase are specific for acute pancreatitis, confirming the diagnosis. Creatinine/BUN, troponin/CK-MB, and bilirubin/calcium are unrelated.
The nurse is preparing to care for four clients. In which order should the nurse plan to attend to the clients?
- A. Client following a thyroidectomy who has hoarseness and an SaO2 of 86%
- B. Client with hyperparathyroidism with a serum calcium level of 10.1 mg/dL
- C. Client with diabetes insipidus drinking frequently and asking for more cold water
- D. Client with hyperthyroidism who has a temperature of 102.2°F (39°C) and tachycardia
Correct Answer: A,D,C,B
Rationale: The thyroidectomy client with low SaO2 has a life-threatening airway issue, followed by the hyperthyroidism client at risk for thyroid storm, the DI client at risk for dehydration, and the stable hyperparathyroidism client last.